Bile duct injuries associated with laparoscopic cholecystectomy: timing of repair and long-term outcomes.
OBJECTIVE
To report on a large experience with laparoscopic cholecystectomy-associated bile duct injuries (LC-BDIs) and examine factors influencing outcomes.


METHODS
A retrospective medical record review. Univariate statistical analysis was used to identify risk factors for postoperative complications.


METHODS
Two university-affiliated hospitals.


METHODS
Sixty-nine patients who underwent surgical repair of LC-BDI between January 1, 1992, and December 31, 2007.


METHODS
Outcomes following repair of LC-BDI, relationship between timing of LC-BDI repair and outcomes, complications, and long-term results following LC-BDI repair.


RESULTS
Thirteen immediate repairs (0-72 hours post-LC), 34 intermediate repairs (72 hours-6 weeks), and 22 late repairs (>6 weeks) were performed. The LC-BDIs were Strasberg type A in 1 patient (1%), D in 2 patients (3%), E1 in 22 patients (32%), E2 in 16 patients (23%), E3 in 22 patients (32%), E4 in 4 patients (6%), and E5 in 2 patients (3%). Forty-one hepaticojejunostomies (59%), 24 choledochojejunostomies (35%), 3 right hepatic hepatectomies with biliary reconstruction (4%), and 1 primary common bile duct repair (1%) were performed. The overall morbidity rate was 30% (21 patients). The mortality rate was 1% (1 patient). Twelve patients (17%) developed short-term postoperative complications. There were no factors found to be associated with early postoperative morbidity. The most common long-term complication was biliary stricture, which occurred in 10 patients (14%). Patients whose BDIs were repaired in the intermediate period were more likely to develop biliary stricture than patients with repairs performed in the immediate or late periods (P = .03).


CONCLUSIONS
Our results suggest that the timing of LC-BDI repair is an important determinant of long-term outcome. Repairs in the intermediate period were significantly associated with biliary stricture. Thus, repairs should be undertaken either in the immediate (0-72 hours) or delayed (>6 weeks) periods after LC.
Sahajpal
Ajay K
AK
Abdominal Transplant Program and Vince Lombardi Cancer Clinic, Aurora St Luke's Medical Center, University of Wisconsin, Milwaukee, Wisconsin, USA.
Chow
Simon C
SC
Dixon
Elijah
E
Greig
Paul D
PD
Gallinger
Steven
S
Wei
Alice C
AC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult