The effect of concomitant vascular disruption in patients with iatrogenic biliary injuries.
OBJECTIVE
To evaluate treatment results in iatrogenic biliary injuries with concomitant vascular injuries.


METHODS
Between January 1998 and May 2002 (inclusive), angiography was performed in 45 of the 105 patients treated for iatrogenic biliary tract injury. The charts of these 45 patients and 5 other patients in whom vascular injury was diagnosed at operation were evaluated retrospectively. Twenty-nine patients had concomitant vascular injury, the biliovascular injury group (BVI), and the remaining 21 patients had isolated biliary tract injury (IBTI).


RESULTS
The most frequent initial operation was a cholecystectomy. The frequency of high-level (Bismuth III or IV) strictures was 90% in the BVI group and 62% in the IBTI group ( P<0.05). Perioperative mortality was 7% in the BVI group and 5% in the IBTI group ( P>0.05). The morbidity in the BVI group was significantly higher ( P<0.05). Two patients in each group were lost to follow up. During a median (range) follow up of 31 months (5-51 months), a successful functional outcome was achieved in 96% of the BVI group and 100% of the IBTI group with a multimodal approach ( P>0.05).


CONCLUSIONS
The frequency of high-level biliary injury and morbidity were significantly higher in the BVI group. However, concomitant vascular injury had no significant effect on mortality and medium-term outcome of biliary reconstruction. Thus, routine preoperative angiography is not recommended.
Bilge
Orhan
O
Hepatopancreatobiliary Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. obilge@superonline.com
Bozkiran
Süheyla
S
Ozden
Ilgin
I
Tekant
Yaman
Y
Acarli
Koray
K
Alper
Aydin
A
Emre
Ali
A
Arioğul
Orhan
O
D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000293:injuries*; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies