Management of Bile Duct Injury Complicating Cholecystectomy: Experience of the General Surgery Department of Avicenne Military Hospital in Marrakesh

Bile duct injuries are the most feared complication of a commonly performed cholecystectomy, which is generally considered as a safe and benign intervention. Eighteen cases of bile duct injuries were collected through a retrospective study conducted between January 2019 and December 2023 in the general surgery department of the Military Hospital Avicenne in Marrakesh. The average age was 53 years old, sex ratio M/F was 0.38. Acute cholecystitis, acute pancreatitis, obesity and anatomical variations were the main risk factors found in our patients. For 13 patients, the iatrogenic injury had occurred in our department. For the remaining 5 patients, they were referred from peripheral hospitals. Intraoperative diagnosis was made in five cases. In the postoperative period, 6 patients had bile leakage from the drain, 5 patients had abdominal pain, one patient presented incisional bile leakage and one patient had a jaundice. The repair consisted mostly on Roux-en-Y hepaticojejunostomy which was performed in 9 cases. Cystic duct ligation was performed in five cases. Two patients underwent primary repair on common bile duct with T-tube insertion. Two cases were treated by endoscopically. The six months’ follow up was favorable for 66,7% of the cases. The prevention and the respect of surgical rules and recommendations (critical view of safety) during cholecystectomy are the best means to avoid these lesions.