Predictors of Morbidity, Mortality, and Long-Term Outcomes After Surgical Repair of Major Bile Duct Injuries: A 10-Year Experience From a North African HPB Center.

BACKGROUND

Major bile duct injury (BDI) is a severe complication of biliary surgery, associated with high morbidity, mortality, and long-term sequelae. This study aimed to identify predictors of outcomes after surgical repair of major BDI in a North African hepatopancreatobiliary center.

MATERIALS AND

METHODS

We retrospectively analyzed 147 patients who underwent repair of Strasberg type E BDI at a single HPB department in Oran, Algeria (2014-2024). Outcomes included morbidity, 90-day mortality, and long-term complications (Terblanche grade > 1). Logistic regression identified independent predictors.

RESULTS

Mean age was 49.1 years, 67.3% were female, and 62.6% sustained injury during laparoscopic cholecystectomy; vascular injury occurred in 17.7%. Hepaticojejunostomy was performed in 95.9%, mostly after delayed referral (> 6 weeks in 91.2%). Morbidity occurred in 35.4%, bile leakage in 16.3%, and 90-day mortality in 4.1%. At a median follow-up of 69 months, 95.8% achieved Terblanche grade 1 outcomes. Independent predictors were laparoscopic index surgery for morbidity (OR = 5.41, 95% CI 1.08-27.09; p = 0.040); age (OR = 1.10, 95% CI 1.01-1.19; p = 0.028), vascular injury (OR = 16.45, 95% CI 2.13-127.20; p = 0.007), and bilirubin ≥ 15 mg/dL (OR = 19.74, 95% CI 1.74-224.53; p = 0.016) for mortality. Immediate repair predicted unfavorable long-term outcomes (OR = 10.44, 95% CI 1.60-68.34; p = 0.014).

CONCLUSION

Hepaticojejunostomy providing durable reconstruction. However, laparoscopic causative surgery, advanced age, vascular injury, and severe hyperbilirubinemia predicted adverse early outcomes, while immediate repair increased the risk of late stricture.