Incidence and Outcomes of Iatrogenic Bile Duct Injuries During Cholecystectomy at Teaching Hospitals in South East Nigeria

Iatrogenic bile duct injury (BDI) during cholecystectomy is a serious complication associated with significant morbidity, litigation, and long-term biliary sequelae. Reliable incidence data and outcome analyses from South East Nigerian institutions are currently unavailable. This study determines the incidence, classification, management, and outcomes of BDI during cholecystectomy at teaching hospitals in Enugu, Anambra, and Imo states from 2018 to 2023. A retrospective multicenter review of cholecystectomy records (n=1,200) was conducted. BDI was classified using the Strasberg system. Management approaches, time to definitive repair, Roux-en-Y hepaticojejunostomy outcomes, and long-term biliary stricture rates were analyzed. BDI occurred in 0.83% of cases, with Strasberg type E injuries carrying the highest morbidity. Delayed recognition beyond 48 hours occurred in 67% of cases. Definitive repair was performed in 81% of patients, with satisfactory long-term outcomes in 74%. Early versus late repair did not significantly affect outcomes when performed by experienced hepatobiliary surgeons. Medicolegal concerns were reported in 28% of BDI cases. The study recommends mandatory use of the Critical View of Safety technique, hepatobiliary surgery subspecialty training, and establishment of a regional BDI referral and management centre in South East Nigeria to optimize outcomes for this serious complication. Keywords: bile duct injury, cholecystectomy, Strasberg, hepaticojejunostomy, South East Nigeria