Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy.
OBJECTIVE
Multiple centers have reported on bile duct injuries after cholecystectomy, but few have reported on the impact of concomitant vascular injuries.


METHODS
Twenty-seven life-threatening complex injuries (CIs) (Bismuth level III, IV, or V or combined arterial-ductal injuries) were retrospectively compared with 22 noncomplex injuries (NCs) (level I or II).


METHODS
Tertiary referral center.


METHODS
The incidence and level of biliary and arterial injuries and their resulting morbidity and mortality.


RESULTS
Bismuth classifications of all injuries were as follows: level I in 6 patients (12%), II in 19 (39%), III in 12 (24%), IV in 8 (16%), and V in 4 (8%). Diagnosis was based on peritonitis (n = 13 [27%]), endoscopic retrograde pancreatography (n = 19 [39%]), and percutaneous transhepatic cholangiography (n = 7 [14%]). Delayed referral was more common in levels I through IV (100 days) than in level V (15 days) (P<.001). Repairs were attempted in level IV (75%), III (67%), V (25%), and II (11%). Thirteen arterial injuries (26%) occurred irrespective of ductal injury level: I (n = 1), II (n = 3), III (n = 1), IV (n = 5), and V (n = 3). There was, however, a higher incidence of repairs before referral in the CI group (59% vs 5%; P<.01), with resulting higher rates of complication (70% vs 23%; P<.01). Five deaths occurred in the CI group vs 1 in the NC group (P =.14). In univariate analysis, the presence of arterial injury vs no arterial injury was a predictor of mortality (5 [38%] of 13 patients vs 1 [3%] of 36 patients; P<.001).


CONCLUSIONS
Bile duct injuries after cholecystectomy can be morbid and lethal with the incidence of arterial injury grossly underestimated.
Buell
Joseph F
JF
Section of Transplantation, Department of Surgery, the University of Chicago, Pritzker School of Medicine, 5841 S Maryland Ave, Chicago, IL 60637, USA. Joseph.buell@uc.edu
Cronin
David C
DC
Funaki
Brian
B
Koffron
Alan
A
Yoshida
Atsushi
A
Lo
Agnes
A
Leef
Jeffery
J
Millis
J Michael
JM
D000328:Adult; D001652:Bile Ducts / Q000293:injuries*; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D006499:Hepatic Artery / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies