title: Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy.
abstract: BACKGROUND
  The aim of the present study was to highlight the advantages of treatment of bile duct injury (BDI) occurring during cholecystectomy on the basis of a multidisciplinary cooperation of expert surgeons, radiologists, and endoscopists.
  
  
  METHODS
  Sixty-six patients had major BDIs or short- or long-term failures of repair. BDI was diagnosed intraoperatively in 27 patients (40.9%) and postoperatively in 39 (59.1%) patients. Among referred patients, 30 had complications from bile leak, 15 from obstructive jaundice, and 20 from recurrent cholangitis. Two patients died from sepsis after delayed referral before repair was attempted. Eleven additional patients had minor BDIs with bile leak both with and without choleperitoneum.
  
  
  RESULTS
  Of patients with major BDI, surgical repair was performed in 41 (64.1%). Postsurgical morbidity rate was 15.8%, and there was no mortality. The rate of excellent or good results after surgical repair was 78.0% (32 of 41 patients), and this increased to 87.8% (36 of 41 patients) by continuing treatment with stenting in postsurgical strictures. Biliary stenting alone was performed in 23 patients (35.9%), with excellent or good results in 17 (73.9%). More than 200 endoscopic and percutaneous procedures were performed for initial assessment, treatment of sepsis, nonsurgical repair, contribution to repair, and follow-up. Patients with minor BDIs underwent various combinations of surgical and endoscopic or percutaneous treatments, always with good results.
  
  
  CONCLUSIONS
  A multidisciplinary approach was of paramount importance in many phases of treatment of BDI: initial assessment, treatment of secondary complications, resolution of sepsis, percutaneous stenting before surgical repair, dilatation of strictures after repair, final treatment in patients not repaired surgically, and follow-up.
authors: Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy. gennaro.nuzzo@rm.unicatt.it
authors: Gennaro
authors: G
authors: Nuzzo
authors: Felice
authors: F
authors: Giuliante
authors: Ivo
authors: I
authors: Giovannini
authors: Marino
authors: M
authors: Murazio
authors: Fabrizio
authors: F
authors: D'Acapito
authors: Francesco
authors: F
authors: Ardito
authors: Maria
authors: M
authors: Vellone
authors: Riccardo
authors: R
authors: Gauzolino
authors: Guido
authors: G
authors: Costamagna
authors: Carmine
authors: C
authors: Di Stasi
mesh_terms: D001652:Bile Ducts / Q000293:injuries*; D001662:Biliary Tract Surgical Procedures; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic; D004322:Drainage; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged