Management of XXXX at Various Stages of Presentation: Experience from a Tertiary Care Centre.

@entity1 @entity295 @entity1157 @entity3116 @entity158 @entity99 @entity255 @entity130
The clinical presentation, management and outcome of all @entity1 with @entity1157 who presented to our tertiary care centre at various stages after cholecystectomy were analyzed. The @entity1 were categorized into three groups: group A- @entity1 in whom the injury was detected during cholecystectomy, group B- @entity1 who presented within 2  weeks of cholecystectomy and group C- @entity1 who presented after 2  weeks of cholecystectomy. Our team acted as rescue surgeons and performed 'on-table' repair for injuries occurring in another unit or in another hospital. Strasberg classification of @entity1157 was followed. In group A, partial and complete transections were managed by repair over T-tube and high hepaticojejunostomy, respectively. @entity1 in group B underwent endoscopic retrograde cholangiogram and/or magnetic resonance cholangiogram to evaluate the biliary tree. Those with intact common bile duct underwent endoscopic papillotomy and stenting in addition to drainage of intra-abdominal collection when present. For those with complete transection, early repair was considered if there was no @entity295 . In presence of intra-abdominal @entity295 an attempt was made to create controlled external @entity3116 . This was followed by hepatico jejunostomy at least after 3  months. Group C @entity1 underwent hepaticojejunostomy at least 6  weeks after the injury. The outcome was graded into three categories: grade A-no clinical symptoms, normal LFT; grade B-no clinical symptoms, mild derangement of LFT or occasional episodes of @entity158 or fever; grade C- @entity158 , @entity255 and abnormal LFT; grade D-surgical revision or dilatation required. Fifty nine @entity1 were included in the study and the distribution was group A-six @entity1 , group B-33 @entity1 and group C-20 @entity1 . In group A, one @entity1 with complete transection of the right hepatic duct (type C) and partial @entity99 ( @entity99 ) underwent right hepaticojejunostomy and repair of the @entity99 over stent. Two @entity1 with type D and three @entity1 with type E 2 injury underwent repair over T-tube and hepaticojejunostomy, respectively. In group B, all except one of the 18 @entity1 with @entity130 underwent endoscopic papillotomy and stenting. The @entity1157 subsided at a mean interval of 8  days in all, except one @entity1 who died of fulminant @entity295 . Of the 15 @entity1 with type E injury, five underwent hepaticojejunostomy after a minimum gap of 3  months. Early repair was considered in 10 @entity1 . Twenty @entity1 in group C underwent hepaticojejunostomy. In a mean follow-up of 40  months, the outcome was grade A in 54 @entity1 , grade B in three @entity1 (one from each of the three groups) and grade D in one @entity1 (group C). The latter @entity1 with a type E3 injury developed recurrent stricture and @entity255 necessitating percutaneous transhepatic dilatation. The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.
