Dr. Sarwar Sobhan

Background: Laparoscopic cholecystectomy (LC) is the gold standard for treating gallstone disease, offering numerous benefits over traditional open cholecystectomy. However, bile duct injuries (BDIs) are a significant complication, contributing to substantial morbidity and mortality. This study aims to evaluate the incidence, causes, risk factors, treatments, and outcomes of BDIs in laparoscopic cholecystectomy in Bangladesh. Material & Methods: This retrospective observational study was conducted at the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University, Al-Manar Hospital Limited, and Abeer General Hospital, Dhaka, Bangladesh. During this period, a total of 1255 complete hospital records of laparoscopic cholecystectomy conducted over the last 5 years at the study hospital were selected for the study following inclusion and exclusion criteria. Results: Out of laparoscopic cholecystectomy cases, 20 (1.64%) patients experienced BDIs. The most common cause of BDI was clipping or transection of the duct (33.33%), followed by mistaken anatomy (22.22%) and ischemic injury due to clip (18.52%). Acute cholecystitis was the most prevalent risk factor (37.04%). Standard laparoscopic cholecystectomy was performed in 83.33% of BDI cases, with the remaining 16.67% undergoing single-incision laparoscopic cholecystectomy. The majority of patients (74.07%) had no complications after BDI treatment, while 18.52% experienced minor complications, 5.56% had major complications, and 1.85% resulted in mortality. Conclusion: This study highlights the importance of meticulous surgical technique, early recognition, and appropriate management of bile duct injuries in laparoscopic cholecystectomy. By continually refining our understanding of the factors contributing to BDIs and implementing evidence-based strategies to prevent and manage this complication, we can optimize patient outcomes and ensure the highest standards of care in laparoscopic cholecystectomy.

Background: A duct-to-mucosa pancreatojejunostomy is technically difficult to perform than Dunking procedure after pancreatoduodenectomy. In contrast, the incidence of anastomotic dehiscence is more in Dunking than duct-to-mucosa procedure. Duct-to-mucosa technique is rarely practiced in our country because of technical difficulties and lack of experiences. Objectives: This study was undertaken to evaluate the safety ofduct-to-mucosa procedure in our patients with pancreatoduodenectomy. Methods: We have performed pancreatojejunostomy in 14 consecutive patients using a duct-to-mucosa technique and the result was assessed. Results: No patients developed pancreato-jejunal leakage; however, 6 of 14 patients developed complications not related to operative techniques (wound infections; 3, jejunal fistula following removal of jejunal feeding tube; 1, renal dysfunction; 1, delayed gastric emptying; 1) which were managed conservatively. There were no postoperative deaths in the present series and the median postoperative hospital stay was 20.3 days. The follow-up period ranged from 1 to 12 months and all patients are surviving with good health during this period. Conclusion: Pancreatojejunostomy by duct-to-mucosal technique is a safe method of pancreatojejunostomy after pancreatoduodenectomy.