**8. Treatment of iatrogenic bile duct injuries – Assesment of results in the surgical treatment of iatrogenic bile duct injuries**

#### **8.1 Short-term results and early complications**

The early postoperative morbidity rate is 20-30% and mortality rate 0-2%. The most frequent early complication is wound infection (8-17.7%). Other complications are the following: bile collection, intra-abdominal abscess, biliary-enteric anastomosis dehiscence, biliary fistula, cholangitis, peritonitis, eventration, pneumonia, circulatory insufficiency, intra-abdominal bleeding, sepsis, infection of the urinary tract, pneumothorax, acute pancreatitis, thrombosis and embolic complications, diarrhea, ileus and multi-organ insufficiency.

Recontructive Biliary Surgery in the Treatment of Iatrogenic Bile Duct Injuries 489

**A** No clinical symptoms from the biliary tract, proper laboratory liver funtion parameters

**B** No clinical signs, laboratory liver function parameters tests slightly elevated liver function parameters, or periodically occurring episodes of pain or fever. **C** Pain, cholangitis with the presence of fever with jaundice and abnormalities in

**II** Minor clinical symptoms due to periodic cholangitis resolved after antibiotic therapy, occurring 2-3 times a year, not requiring hospitalization. Proper liver function tests, except of increased serum bilirubin and alkaline phosphatase, with

**III** Severe recurrent cholangitis, occuring in more 3 times a year,, lasting over a week and requiring hospitalization. Laboratory tests showing a tendency do increased ALT and AST and transit but rapid increased serum bilirubin and alkaline

**Good result** Cholangitis 1-2 a year without jaundice, and without debilitating normal life and work of the patient. **Poor result** Often repeated bouts of cholangitis with jaundice, showing

The early and proper treatment of IBDI is very important, because it can prevent serious complications and improve quality of life in patients. Non-invasive methods are used as initial treatment. When it is not effective, surgical management should be considered.

recurrence of stenosis.

Surgical treatement includes different types of reconstructions.

**D** Condition requiring surgical or endoscopic correction.

rapid normalization after symptoms resolution.

**I** Without pain, normal liver function tests.

Table 10. Lygidakis i Brummelkamp classification.

**Very good result** Without clinical symptoms.

tests.

laboratory tests.

phosphatase.

**I** Asymtomatic course. **II** Minor clinical symtoms. **III** Recurrent cholangitis.

Table 11. Muňoz-Cardenas classification.

Table 12. Nielubowicz classification.

**9. Conclusion** 

Table 9. McDonald classification.
