Post Cholecystectomy Biliary Injuries; 25 Years’ Experience in Management Using Different Treatment Strategies and Modalities in Tertiary Centers

Purpose: the aim of this study was to assess management protocols for post-cholecystectomy biliary injuries.
Patients & Methods: 510 patients were enrolled between 1998 and 2023, and were treated with surgery (153), endoscopy (421), and percutaneous techniques (41).
Results: Biliary injuries were still commonly encountered and managed in a stepwise manner. Endoscopy was successful initial treatment of 421/510 patients (82.5%), being less invasive, low morbidity and mortality, and competitive in treating leakage in 80%, and strictures in 70% of cases. The addition of percutaneous techniques increased its success rate by 3% to 5% for strictures and leakage respectively. However, endoscopy was complementary in major leakage, and massive stricture where surgery was needed in 20-23% of cases. Surgery is still the preferred course of action for biliary peritonitis, CBD transection, ligation, and complicated damage in 70% of cases. In all; bilio-enteric anastomosis was the preferred method ( 77 cases). Seven individuals (4.6%) had a stricture complication; three of these instances were treated by percutaneous rout, and four cases required repeat surgery. The learning curve appears to have an impact, and experience builds up over time to improve success and reduce problems.
In summary, endoscopy was found to be complementary to surgery in complex disorders where surgery plays a major role, but it was found to be competitive with surgery in simple conditions and recommended as the initial treatment choice. Experience affects care and is required for management with other facilities.