Incidence, pattern and management of bile duct injuries during cholecystectomy: experience from a single center.
BACKGROUND
The incidence and pattern of bile duct injury (BDI) may be underreported because of the heterogeneous referral from multiple institutions.


METHODS
Retrospective analysis of data from 5,782 cholecystectomies performed between 1989 and 2007 was done. BDI were categorized into Strasberg types.


RESULTS
Fifty-seven (1%) patients sustained BDI. Ten of 57 (18%) patients had minor BDI (type A-10), 25/57 (44%) had major BDI (type C-3, type D-14, type E-8) and BDI could not be classified in the remaining 22/57 (39%) patients. Twenty-one of 25 (84%) major BDI were detected at operation - 21/57 (37%) injuries were detected and repaired intra-operatively. The other 36/57 (63%) injuries were detected after operation - 11 were managed expectantly, 5 had endoscopic stenting, 3 underwent percutaneous drainage of bilioma, 1 had a laparoscopic clipping of the subvesical duct, 4 underwent laparotomy and 12 required a combination of interventions. Five of the 57 (9%) patients died. At follow-up, 1 patient developed bile duct stricture which was managed endoscopically. All other patients were doing well at the last follow-up.


CONCLUSIONS
In experienced centers, most of the major BDI can be detected and managed during cholecystectomy. Good results can be achieved by judicious selection of a combination of interventions in the majority of patients.
Pottakkat
Biju
B
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Vijayahari
Ranjith
R
Prakash
Anand
A
Singh
Rajneesh Kumar
RK
Behari
Anu
A
Kumar
Ashok
A
Kapoor
Vinay Kumar
VK
Saxena
Rajan
R
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery; D055815:Young Adult