Study of complications and their management after biliary tract surgery: a study of 50 cases

Background: Post-operative complications following biliary tract surgery vary widely, and comprehensive data on their patterns, management, and outcomes remain limited, especially in resource-constrained settings. The aim of the study was to evaluate the types, clinical features, management strategies, and outcomes of complications following biliary tract surgery in 50 patients. Methods: This prospective study at the Department of Surgery, Dhaka Medical College Hospital (DMCH), and Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from January 2007 to February 2008 included 50 patients with complications following biliary tract surgery, excluding combined biliary, pancreatic, or stomach procedures. Patients underwent detailed history, examination, and investigations (USG, LFT, ERCP, MRCP). Minor complications were managed conservatively, major complications surgically (Roux-en-Y hepaticojejunostomy/ choledochojejunostomy), and retained stones endoscopically, with outcomes assessed on follow-up. Results: Among 50 patients, most were male (43, 86%) and aged 31-50 years (37, 74%). Minor bile leak (20%) and bile duct injuries (30%) were the most common complications, with jaundice (40%) as the main clinical feature. Laparoscopic cholecystectomy caused 80% of injuries. Most presented within 1 month (70%). Management included operative (40%), non-operative (34%), and endoscopic (10%) approaches, with Roux-en-Y hepaticojejunostomy being the most frequent procedure (60%). Follow-up showed recurrent cholangitis (14%) and restricture (4%). Conclusions: Biliary tract injuries, particularly after laparoscopic cholecystectomy, remain a serious concern, with timely recognition, careful surgical technique, and Roux-en-Y hepaticojejunostomy being key to management, while prevention and vigilant long-term follow-up are essential to optimize outcomes.