Study of post cholecystectomy biliary leakage and its management

The biliary tract is a complex organ system that performs the simple though vital task of collecting, storing, and delivering bile to the gastrointestinal tract. Diseases of the biliary tract can be extremely painful, debilitating, and occasionally life threatening. the complex development of the liver and biliary system in utero can result in multiple anatomic variations. An absolute knowledge of these anatomic variations with careful dissection and identification of structures at the time of surgery is a minimal requirement for the safe performance of any hepatobiliary operation. Because of the unforgiving nature of the biliary system, errors in technique or judgment can be disastrous to the patient, resulting in lifelong disability or death. For this reason, a high premium exists on performing the correct procedure, without technical misadventure, the first time. Equally important is the ability to recognize iatrogenic injury so that prompt repair or referral to a surgeon who has expertise in hepatobiliary surgery can be instituted. Positive outcome requires a balance between sound judgement, technical acumen, and attention to detail. Additionally, the surgeon of today must be able to integrate surgical options with the broadening array of radiologic and endoscopic treatment options available in the management of patients who have these disorders. Also because of the great frequency with which the operation is performed, cholecystectomy remains the greatest source of post-operative biliary injuries. In a review of more than 42,000 open cholecystectomies performed in the United Statess in 1989, the incidence of incidence of biliary injuries was documented to be 0.2%. Strasberg and associates reported a 0.3% incidence of injuries in a literature review of more than 25,000 open cholecystectomies since 1980. The advent and preference for laparoscopic cholecystectomy has refocused attention on this issue, however because of the significant increase in the number of injuries. Several studies worldwide have documented a marked increase in the frequency of bile duct injuries associated with the laparoscopic approach, ranging from 0.4% to 1.3%. Also in a review of nearly 125,000 laparoscopic cholecystectomies reported in the literature in the years 1991-1993, Strasbeg and colleagues reported an overall incidence of biliary injuries of 0.85%.