[Surgical injuries to the main bile ducts and their sequellae in "open" biliogastroduodenal surgery]

There are studied 53 patients (1984-1995) with surgical injuries (and/or sequels) of the main biliary duct (MBD) produced during biliary and gastro-duodenal "open" interventions. The patients are classified in the following categories: I) 7 (13%) with the ductal accident diagnosed and repaired in the time of the same operation. Produced in our clinic (0.13% of the total predisposing operations), all patients healed and there was not postoperative mortality. 2) 46 (87%) patients admitted from others surgical units: a) 17 with an immediate or precocious diagnosis of the surgical MBD trauma and b) 29 with late diagnosis having various MBD strictures (6 of them have had corrective interventions which became ineffective in time). All the patients have had overadded around 3 risk factors. The principles applied in the treatment of this iatrogenic lesions were: # If the surgical injury was recognised during the causal operation--immediate repair: various ductal sutures or anastomosis with stent support maintained approximately 6-9 months. # The accident was discovered soon postoperatively: the remedial operation was postponed for a second time, after the surgical treatment of the evident complications (jaundice, angiocolitis, choleperitoneum, fistulas, etc). # The late diagnosed strictures of the MBD (without other local septic complications) benefited particularly by bilio-jejunal derivations (21 patients--72% from 29). The postoperative morbidity and lethality: 9 patients (19,5%/46), the main cause being different septic complications. 34 patients (64%/53), which we can followed, were alive between 2 and 10 years postoperatively. The best treatment of the surgical injuries of the MBD during the different biliary or gastroduodenal operations (practiced "à ciel ouvert") is their avoidance.