Outcomes of Reconstructive Hepaticojejunostomy for Post-Cholecystectomy Bile Duct Injuries

Objectives: Bile duct injury (BDI) remains a potentially devastating complication of 
cholecystectomy. BDI is associated with significant morbidity, high costs, impaired quality of life, 
and decreased survival. After major BDI, reconstructive surgery by Hepaticojejunostomy (HJ) is 
usually indicated The study aimed to analyze and evaluate the presentation, characteristics, related 
investigation, and outcomes of reconstructive Hepaticojejunostomy in patients with postcholecystectomy bile duct injuries. Patients and methods; This study was done in El-Minia 
university hospital (minia Hepatobiliary unit), including 26 patients who underwent 
Hepaticojejunostomy Roux-en-Y for post-cholecystectomy bile duct injury (BDI) between May 
2017and May 2020, retrospectively and prospectively. Results: The study included 26 patients 
suffered from iatrogenic BDIs; 19 patients (73%) underwent OC, and 7patients (27%) underwent LC.
Regarding injury type; the Leaking, Obstructing, collection, peritonitis, and vascular injuries were 
26.9%, 46.1%, 19.3%, 7.7%, and 4.4% respectively. However, the Strasberg classification of injury 
was as follow E1 = 15.4%, E2 = 46.1%, E3 = 30.8%, and E4 = 7.7%. In this retrospective study, 
between may 2017and December 2020, 26 patients with major bile duct injuries sustained during 
cholecystectomy and requiring surgical treatment in the form of HJ Roux-en-Y were referred to minia
hepatobiliary center Preoperatively, US was done for all patients, CT in 3(11.5%), PTC in 3(11.5%), 
ERCP in 17(65%) and MRCP was done for 16 (61.5%) patients. Conclusion: Early detection of BDI 
and early referral to specialized hepatobiliary referral centers are essential for early management of 
BDI and prevention of its complications and any attempt of repair by non-specialized general surgeon 
should be avoided. Surgical reconstruction using Roux-en-Y Hepaticojejunostomy mucosa to 
mucosa repair remains the golden standard procedure of choice for treating these injuries with 
successful outcome and better long-term result. We recommend long-term follow up of the patients 
after surgical repair for at least 10 years as anastomotic stricture was diagnosed after long peroid. 
Further studies should be performed for the best management of recurrent anastomotic stricture. 
Associated vascular injuries should be emphasized and accurately evaluated.