title: Specialist outreach service for on-table repair of iatrogenic bile duct injuries--a new kind of 'travelling surgeon'.
abstract: BACKGROUND
  The objective of this study was to determine the outcome of on table repair of iatrogenic bile duct injuries (IBDIs) following laparoscopic cholecystectomy, by specialist hepatobiliary surgeons as an outreach service.
  
  
  METHODS
  Prospectively collected data on IBDI managed as an outreach service, was analysed retrospectively. The Strasberg classification was used to define types of injury.
  
  
  RESULTS
  There were 22 patients. Twenty (91%) had type E 'classical' excision injuries, two had types B and D. Two type E cases had co-existent vascular injury both with right hepatic artery injuries; one also had a co-existent portal vein injury. A Roux-en-Y hepaticojejunostomy was used to repair the IBDI in 21 (95%) patients. One type D injury had duct repair over a T-tube. No attempt was made to reconstruct the injured hepatic arteries, while the portal vein injury was primarily repaired. The median follow-up was 210 days (range, 47-1088 days). Two patients developed bile leak and cholangitis while another developed transient jaundice. There were no postoperative mortalities. All patients were followed up at our centre.
  
  
  CONCLUSIONS
  Repair of IBDI as an outreach service by specialist surgeons is feasible and safe, with minimal disruption to the patient pathway. Prompt recognition and definitive management may help reduce complaints and medicolegal litigation.
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Silva
authors.forename: C
authors.initials: C
authors.lastname: Coldham
authors.forename: A D
authors.initials: AD
authors.lastname: Mayer
authors.forename: S R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: J A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: D F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000293:injuries / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D013502:General Surgery / Q000458:organization & administration*; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies