title: Improvement in the management of bile duct injuries?
abstract: BACKGROUND
  Previous studies have suggested that improvements in diagnostic workup and treatment of bile duct injuries (BDI) sustained during laparoscopic cholecystectomy can be expected as experience increases with the laparoscopic procedure. Many published articles reported that early diagnosis, proper classification, and optimal timing of treatment of BDI increase the likelihood of successful treatment. This study determined whether diagnosis and management of BDI have improved over the years.
  
  
  METHODS
  Between June 1990 and November 1996, 106 patients were diagnosed and treated in the Amsterdam Academic Medical Center for BDI sustained during laparoscopic cholecystectomy. Detailed information was obtained about peroperative findings, time interval from laparoscopic cholecystectomy to symptoms, and interval from symptoms to diagnosis. Bile duct injuries were classified into four types. Two patient groups were compared: BDI patients diagnosed from 1990 until 1994 ("learning phase") and patients diagnosed from 1995 until 1996.
  
  
  RESULTS
  Bile duct injuries combined with bile leakage were diagnosed significantly earlier in the second period after the learning phase. The percentages of injuries diagnosed peroperatively, "blind laparotomies," and suboptimal timed hepaticojejunostomies were not different between the groups.
  
  
  CONCLUSIONS
  Except for earlier diagnosis of BDI in the later period than in previous years, there appeared to be no significant improvement in diagnostic workup and management during the past 2 years.
authors.affiliation: Department of Surgery, Amsterdam Academic Medical Center, The Netherlands.
authors.forename: Y C
authors.initials: YC
authors.lastname: Keulemans
authors.forename: J J
authors.initials: JJ
authors.lastname: Bergman
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: E A
authors.initials: EA
authors.lastname: Rauws
authors.forename: K
authors.initials: K
authors.lastname: Huibregtse
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D013997:Time Factors