الفهرس 
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Abstract
Bile duct injuries (BDI) take place in a wide spectrum of clinical settings. Iatrogenic BDI may result from gallbladder, pancreatic and gastric surgery.
Cholecystectomy is responsible for 80%-85% of BDI. The incidence of BDI following laparoscopic cholecystectomy is (0.2%-0.4%), despite the expertise gained worldwide in performing this procedure. BDI is still higher in laparoscopic than open cholecystectomy.
Multidisciplinary approaches were proposed for management of BDI including endoscopic retrograde cholangiopancreatography (ERCP) with stent or balloon dilatation, radiological such as percutaneous transhepatic dilatation or drainage (PTD) Or surgical in the form of biliary reconstruction.
The surgical biliary tract reconstruction is the best treatment options for most major bile duct injuries. The goal of surgical repair of the BDI is the restoration of a durable bile conduit, and the prevention of long-term complications as recurrent cholangitis and secondary biliary cirrhosis & hepatic failure.
Long-term outcome is the most important in assessment of results of iatrogenic bile duct injury (IBDI) surgical treatment. In referral hepatobiliary centers, a successful outcome after surgical repair of IBDI is observed in 70-90% of patients.
HJ may result in long-term complications such as stricture formation, recurrent cholangitis and secondary biliary cirrhosis (SBC). Anastomotic stricture after HJ is reported to range from 2% to 25%. An absence of biliary anastomotic stricture is a proof of successful surgical management.
In this retrospective study, between may2017and December 2020, 26 patients with major bile duct injuries sustained during cholecystectomy and requiring surgical treatment in the form of HJ Roux-en-Y were referred to minia hepatobiliary center Preoperatively, US was done for all patients, CT in 3(11.5%), PTC in 3(11.5%), ERCP in 17(65%) and MRCP was done for 16 (61.5%) patients.
Level of injury type (E2) was the most common type (12-46.2%).
As regard preoperative management, 4(15.4%) patients with intra-abdominal collections underwent US guided TD., 3(11.5%) patients underwent exploration for biliary peritonitis
All patients underwent HJ Roux-en-Y for biliary reconstruction. The most common early surgical complications were bile leak in 4 (15.4%) patients. intra-abdominal collection in 2 (7.8%)patients.
24 patients underwent long-term follow up with The median follow-up was 13 (1–35) months.
Long-term complications were detected in 5(20.8%) out of 24 patients with long-term follow up; in the form of recurrent cholangitis 2(8.3%); where the initial attacks developedat 6 months, 10 months, 17 months, 30 months from definitive surgery, stricture 2(8.3%), that occurred at 9 months,21 months, 22 months, 25 months, from surgery, and both stricture and recurrent cholangitis 1(4.2%), that happened at 18 months and 25 months from surgery
The long-term outcome according to Terblanche clinical grading system was excellent (grade I) in 16 (66.7%) patients, good (grade II) in 5 (20.8%) patients, fair (grade III) in 2 (8.3%) patients and poor (grade IV) in 1 (4.2%) patients. As regard McDonald’s grading, grades A, B, C, and D were 16/24(67%),5/24(21%),2/24(8%), and 1/24(4%) respectively.