• E Degiannis, K Khelif, E Leandros, K Boffard, and R Saadia.
• Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa. degiannis@yebo.co.za
• Eur J Surg. 2001 Aug 1;167(8):618-21.

ObjectiveTo assess our management of gunshot injuries of the extrahepatic biliary ducts.DesignRetrospective study.SettingUrban teaching hospital, South Africa.Subjects17 patients who were found to have gunshot injuries of the extrahepatic bile ducts, January 1993-June 1998.InterventionsPacking and damage control, staged repair, or definitive repair.Main Outcome MeasuresMorbidity and mortality: Three of the 17 died intraoperatively or postoperatively from causes unrelated to the biliary injury. Of the 14 survivors, 3 were managed initially with packing and damage control, 7 by staged repair, and 4 by definitive biliary repair. Eleven patients had a Roux-en-Y biliary jejunostomy, of whom 1 developed a late biliary stricture related to a postoperative anastomotic leak. End-to-end anastomosis of the bile duct was done for 2 patients and they both developed late biliary strictures. Ligation of the injured duct and cholecystojejunostomy was done for I patient.ConclusionRoux-en-Y biliary-jejunal anastomosis is appropriate in the treatment of gunshot injuries of the extrahepatic biliary ducts as there is always a degree of tissue loss and some debridement is required, making it difficult to do a tension-free anastomosis.

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