Incidence and Outcomes of Bile Duct Injury Following Laparoscopic Cholecystectomy at Kenyatta National Hospital

Abstract

BackgroundThe increasing utilization of laparoscopic cholecystectomy has been linked with an increase in bile duct injuries, described as one of the direst complications following cholecystectomy. Bile duct injuries carry a significant postoperative morbidity and mortality rate with associated bearing on the reputation and mental health of the surgeon as well as a notable financial impact on healthcare structures. The timing of diagnosis and intervention taken have a noteworthy effect on long-term quality of life. The incidence of these injuries and outcomes of management initiated following their occurrence have not been documented locally. Objective To establish theincidence and outcomes of bile duct injury following laparoscopic cholecystectomy at Kenyatta National Hospital (KNH). MethodologyThis was a retrospective study of data gathered and stored in the KNH registry of laparoscopic cholecystectomies performed between January 2015 and December 2022.A total of 161 patients who had undergone laparoscopic cholecystectomy over the study period wereincluded. The data gathered included patients’ demographic characteristics, indications for surgery, injury incidence, timing of diagnosis, and outcomes. Data was entered into SPSS version 26 for analysis. The data was analyzed for means and proportions. Association was established through chi-square and statistical significance analysis at a 95% interval level with a p-value of <0.05 being a significant difference. The results were presented in tables and graphs. Results A total of 161 patients who underwent laparoscopic cholecystectomy were included in the study, with a median age of 41 years and female preponderance of 85.1%. 82.6% of patients had symptomatic cholelithiasis. The incidence of bile duct injury in patients undergoing laparoscopic cholecystectomy at KNH was 5% with 95% Confidence Interval [CI]: 2.2% to 9.6%. There was a significant difference in the duration of surgery among patients who had BDI (174 minutes) and those who did not have BDI (125.9minutes). 37.5% of the patients had an early diagnosis, 25% had an intermediate diagnosis and 37.5% had a delayed diagnosis. 50% of patients with BDI had Strasberg class A injury. All the patients who were diagnosed intraoperatively had primary repair and a mean length of stay of 7 days. Among those who were ` xi diagnosed post-operatively, the commonly presenting features included deranged LFTs (100%), jaundice (80%), and abdominal pain (60%), with 60% of these managed by ERCP with stenting. Delayed secondary repair over a T tube was associated with a bile leak, p 0.014. The mean length of hospital stay following management of postoperatively diagnosed BDI was 14 days.Surgical site infection was the most common complication after management of LC-BDI (25%). No mortalities were reported. Conclusion A high index of suspicion in cases of altered anatomy and local inflammation and employing safe cholecystectomy strategies will likely reduce the incidence of injuries. Immediate repair of intraoperatively diagnosed bile duct injury is safe, has desirable long-term outcomes, and is associated with shorter hospital stays. Keywords Laparoscopic cholecystectomy, bile duct injury, incidence, outcome