الفهرس 
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Abstract
Aim of the work : This prospective study aims to evaluate postcholecystectomy bile duct injuries as regard diagnosis, management, and outcome after surgical reconstruction. Patients & methods :This study was conducted in Gastroenterology Surgical Center, Mansoura University on 56 patients having bile duct injuries after cholecystectomy. During the period from October 2004 to December 2006 the patients were 16 males (28.6%) and 40 females (71.4%) with a mean age of 40.4±11.7 years. Bile duct injuries occurred in 46 patients (82.1%) after open cholecystectomy and in 10 patients (17.9%) after laparoscopic cholecystectomy. There were 49 patients with major injury and 7 patients with minor injury which were subjected to other line of treatment. The most common presentation was jaundice. H.J. was done in 48 patients (98%), and stent was placed in the anastomosis in 2 patients (4.1%) due to narrow anastomosis and left lateral segmentectomy and right hepaticojejunostomy was done for one (2%) patient. while those with minor injury(7 patients) were treated by ERCP and stent only. Results: early postoperative complications which were abdominal collection in 5 patients (10.2%), bile leak in 8 patients (16.3%), wound infection in 3 patients (6.1%), and faecal leak in one patient (2%). For abdominal collection, U.S. guided tubal drainage was done in 4 patients (8.2%) and aspiration for one patient (2%). Conservative treatment was successful for bile leak and need no further treatment. The mean hospital stay was 7.3±5.7 days. No hospital mortality occurred. The mean follow-up interval is 26.83±7.73 month. The outcome results were excellent in 35 patients (71.5%), good in 10 patients (20.4%) while poor outcome was in 3 patients (6.1%), one of them (2%) was recurrent stricture for her MRCP was done and refashioning of HJ was done after 21.5 months, and Liver cell failure in one patient (2%) which was contributed mainly to viral hepatitis (HCV). Conclusion: The optimal management of patients with major bile duct injuries and strictures in the current era remains surgical reconstruction. The success of the initial repair after bile duct injury is critical to the long-term patency and function of the biliary tract. Dissection of the hilar plate, obtaining adequate width of the hepatic duct opening, and accurate mucosa-to-mucosa anastomosis are essential to achieve satisfactory reconstruction of the biliary tract .