Outcomes of Complex Iatrogenic Biliary Tract Injuries: Retrospective Single-Center Experience from Pakistan

Area of Science:

• Hepatobiliary Surgery
• Surgical Complications
• Gastroenterology

Background:

• Iatrogenic bile duct injury (IBDI) is a recognized complication following cholecystectomy.
• Sequelae include biliary peritonitis, cholangitis, cirrhosis, sepsis, and mortality.
• Early referral to high-volume hepatobiliary centers is crucial for effective management.

Purpose of the Study:

• To analyze the clinical presentation, injury grading, surgical strategies, and outcomes of IBDI patients.
• To evaluate the success rates of various surgical procedures for IBDI.
• To identify risk factors influencing postoperative morbidity and mortality.

Main Methods:

• Retrospective analysis of 79 IBDI patients undergoing surgery between January 2019 and January 2025.
• Data collection included patient demographics, injury details, surgical procedures, and outcomes.
• Statistical analysis involved frequencies, percentages, and odds ratios for mortality risk.

Main Results:

• Hepaticojejunostomy was the most common procedure (60.8%), followed by redo hepaticojejunostomy (20.3%).
• Overall success rate was high at 96.2%, with low hospital mortality (2.5%).
• Postoperative morbidity (29.1%) was higher in complex injuries with vascular involvement.

Conclusions:

• IBDI requires specialized surgical expertise; initial attempts at reconstruction should be avoided if inadequate.
• Prompt referral to high-volume hepatobiliary centers improves patient outcomes.
• While complex injuries increase hepatectomy risk and recovery time, outcomes remain favorable with appropriate treatment.