Long-term results of major bile duct injury associated with laparoscopic cholecystectomy.
BACKGROUND
Major bile duct injury (MBDI) is the most serious complication associated with laparoscopic cholecystectomy (LC). This study reports on long-term outcomes and clinical factors which predicted the outcome of 25 patients with LC-associated MBDI.


METHODS
Twenty-five consecutive patients receiving either primary (n = 11) or redo (n = 14) biliary reconstructive surgery at Cathay General Hospital for LC-associated MBDI were prospectively followed for 2 to 10 (mean, 4.5) years to assess their long-term outcomes. Twelve clinical factors relevant to their outcomes were analyzed.


RESULTS
There was no mortality. Although the 1-year postoperative results were successful in 23 patients (92%), the mid- to long-term outcomes were successful in only 17 patients (68%). Eight patients (32%) developed biliary strictures at an average of 3.3 years postoperatively and required subsequent reoperation or biliary stenting. Statistical comparison of 12 risk factors between the successful and unsuccessful groups revealed that two were significant, namely, repair performed by a nonreferral surgeon (p = 0.02) and repair at a stage with recent active inflammation (p = 0.04). A serum alkaline phosphatase level greater than 400 IU in the sixth postoperative month was highly correlated with long-term nonsuccess (p = 0.01).


CONCLUSIONS
Only 68% of patients with LC-associated MBDI who underwent reconstructive surgery at our institution had long-term success. A serum alkaline phosphatase level above 400 IU in the sixth postoperative month was predictive of nonsuccess. For better long-term results, repair should be performed by the referral surgeon at a stage without coexisting active inflammation.
Huang
C S
CS
Department of Surgery, Cathay General Hospital, Taipei Medical University, Taipei, Taiwan. cshuang@ms1.cgh.org.tw
Lein
H H
HH
Tai
F C
FC
Wu
C H
CH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D001652:Bile Ducts / Q000293:injuries*; D015415:Biomarkers; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D004106:Dilatation; D004322:Drainage; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D015607:Stents; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D000469:Alkaline Phosphatase