Introduction: Biliary tract injury is a rare but serious complication of cholecystectomy that can have disastrous consequences in terms of morbidity, mortality and healthcare costs. Furthermore, these injuries have an impact on the long-term quality of life of young patients, which must be taken into consideration before any biliary repair is performed. The aim of our study is to highlight the difficulties encountered during these iterative repairs and to evaluate their outcomes.
 
Method: Eighty patients who had suffered a surgical wound to the bile duct during laparoscopic cholecystectomy were referred to us. As part of this retrospective study, we took into account the severity of the injuries, the number of repairs, the failures of iterative bile duct repair, and the impact on patients’ quality of life.
 
Results: In most cases, these were young women who underwent surgery for gallstones. Intraoperative cholangiography was not performed in 76% of patients. In 34 patients, the lesion was identified intraoperatively. In the other patients, conversion and/or reoperation was required. We received these patients for complications often associated with this condition (peritonitis, deep suppuration, external biliary fistulas and jaundice). Some patients were referred by the surgeon responsible for the wound after one or more attempts at repair or drainage. Others were treated as emergencies following complications (jaundice, peritonitis, external biliary fistula) or even multiple organ failure (renal and hepatic). The severity of these injuries is exacerbated by the infectious syndrome associated with fibrosis resulting from repeated repairs (64%). Initially, we treated the complications: 28 surgical procedures for biliary peritonitis and 12 percutaneous drainages. In three patients, we performed early biliary repair using a Roux-en-Y loop. Twelve patients required dialysis for acute renal failure and two patients required assisted ventilation in intensive care for pulmonary embolism. Definitive repair was performed on average two months later, using a bilio-digestive bypass on a Y-shaped loop. A young female patient developed secondary biliary cirrhosis, which was treated with a liver transplant (right lobe from a living related donor).The overall morbidity rate was 36.5%, with a long hospital stay and delayed return to normal activities.
 
Conclusion: Surgical reconstruction yields excellent or good results in the vast majority of patients with post-cholecystectomy bile duct injury. A longer delay before definitive repair and a previous repair attempt were significant independent predictors of an unsatisfactory long-term outcome. It is therefore strongly recommended that patients be referred promptly to referral centres. tertiary centres with experienced hepatobiliary surgeons for definitive treatment in order to achieve satisfactory long-term results.
 
Keywords: bile duct injuries, timing of repair, treatment strategy, aftereffects.