title: Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries.
abstract: Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) remains a significant surgical challenge. Despite claims to the contrary, the incidence of bile duct injury has remained elevated since the introduction of LC. Several issues regarding the surgical management of BDI are controversial, including: (i) identification of the surgeon and centre most capable of managing the injury, (ii) timing of surgical repair, (iii) incidence and significance of associated vascular injury and (iv) identification of patient factors which significantly impact outcome after repair. Variability in timing of referral of BDI to tertiary centres has been noted in the literature. The impact of timing of referral upon post-operative outcomes after definitive surgery has yet to be clearly investigated. We report our experience with 44 patients who required reconstructive surgery after BDI. In contrast to the many studies available in the literature, patients in the current study were classified according to a modern injury classification system. Additionally, we examined the impact of delayed referral to our centre on short- and long-term outcomes after surgical repair of BDI.
authors: Department of Surgery, Weill Cornell Medical College, The Methodist Hospital Department of Surgery, Houston, TX 77030, USA. cpfischer@tmhs.org
authors: Craig P
authors: CP
authors: Fischer
authors: Bridget N
authors: BN
authors: Fahy
authors: Tom A
authors: TA
authors: Aloia
authors: Barbara L
authors: BL
authors: Bass
authors: A Osama
authors: AO
authors: Gaber
authors: R Mark
authors: RM
authors: Ghobrial