RECONSTRUCTION OF EXTRA-HEPATIC BILIARY TREE IN IATROGENIC INJURY CAUSING BISMUTH I, II, AND III LESIONS

Aim: It has been considered that iatrogenic injuries of the common bile duct can best be repaired with biliary enteric anastomosis between a Roux loop of jejunum and the proximal extra hepatic biliary tree. This study aim to assess the feasibility of Choledochocholedochostomy in biliary reconstruction in iatrogenic biliary injury of Bisthmus I,II and III levels. Patients and Methods: eight patients who had iatrogenic biliary tract injury of Bisthmus II and III levels were prospectively included .The anatomic conditions of the biliary tree were evaluated by endoscopic cholangiography or cholangio resonance. Choledochocholedochostomy was done in all patients with mucosa to mucosa tension free anastomosis, after inserting the T tube (silicone or latex) in the distal segment. Johns Hopkins criteria for evaluation of reconstruction results was used. Results: eight patients were surgically reconstructed. Mean age was 38.12 years (range 23 - 65), Six were female. Treatment success (excellent or good results) was obtained in 7 cases according to Johns Hopkins criteria for evaluation of reconstruction. Mean follow up was 17.5 months (range 12 to 23 months). There was a single case of mortality with pulmonary embolism while morbidity is limited only to mild wound sepsis in 2 cases. Conclusion: Choledochocholedochostomy is always feasible in Bisthmus II and III biliary injury Long term follow up is awaited to assess our promising initial results