The Predisposing Factors for Post Cholecystectomy Biliary and Vasculobiliary Injuries: a Prospective Study

Background: Biliary and vasculobiliary injuries are commonly reported post- cholecystectomy events with various incidence rates depending on different risk factors. Assessing these factors is important in designing prevention strategies.

Aim of study: To assess the predisposing factors related to post cholecystectomy biliary and vasculobiliary injuries.

Patients and methods: A clinical prospective study carried out in the Gastroentrology & Hepatology Teaching Hospital/ Medical City Complex in Baghdad-Iraq through period of two years from 1st of February, 2021 to 31st of March, 2023 on sample of 50 patients with Biliary and vasculobiliary injuries. All patients with Biliary and vasculobiliary injuries referred from other hospitals to Gastroentrology & Hepatology Teaching Hospital were dealt with them by multidisciplinary team and received best available management option decided. Results: Common local factors were chronic cholecystitis (30%), acute cholecystitis (24%), bleeding (24%), followed by; previous laparotomy (16%) and biliary & vascular anomaly (6%). The surgeon experience was specialist in 82% of patients with post-cholecystectomy biliary injuries, while implemented by resident surgeon in 18% of cholecystectomies. The common clinical presentation of post- cholecystectomy biliary injuries was jaundice (36%) and laparoscopy was the common type of cholecystectomy (80%), while recognition of bile injury was immediate in 18% of patients.

Conclusions: The common local factors of post-cholecystectomy biliary and vasculobiliary injury are chronic or acute cholecystitis and bleeding. Female gender, clinical co-morbidity, low expertise of surgeon, governmental hospital and laparoscopy cholecystectomy are risk factors for post-cholecystectomy biliary injury.