title: Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injuries is associated with an improved long-term outcome.
abstract: BACKGROUND
  A majority of bile duct injuries (BDI) sustained during laparoscopic cholecystectomy require formal surgical reconstruction, and traditionally this repair is performed late. We aimed to assess long-term outcomes after repair, focusing on our preferred early approach.
  
  
  METHODS
  A total of 200 BDI patients [age 54(20-83); 64 male], followed up for median 60 (5-212) months were assessed for morbidity. Factors contributing to this were analyzed with a univariate and multivariate analysis.
  
  
  RESULTS
  A total of 112 (56%) patients were repaired by specialist hepatobiliary surgeons [timing of repair: immediate, n = 28; early (<21 days), n = 43; and late (>21 days) n = 41], whereas 45 (22%) underwent repair by nonspecialist surgeons before specialist referral [immediate, n = 16; early, n = 26 and late, n = 03]. Outcomes after immediate and early repairs were comparable to late repairs when performed by specialists [recurrent cholangitis:11%, 12%, and 10%; P = 0.96, NS; re-stricture:18%,5%, and 29%; P = 0.01; nonsurgical intervention: 14%, 5%, and 24%; P<0.03; redo surgery: 4%, 2%, and 5%; P = 0.81, NS; overall morbidity: 21%, 14%, and 39%; P<0.02]. On multivariate analysis, immediate and early repairs done by nonspecialist surgeons were independent risk factors (P < 0.05) for recurrent cholangitis [50% and 27%], re-stricturing (75% and 61%), redo reconstructions (31% and 61%), and overall morbidity (75% and 84%).
  
  
  CONCLUSIONS
  Immediate and early repair after BDI results in comparable, if not better long-term outcomes compared to late repair when performed by specialists.
authors.affiliation: University Hospital Birmingham, Birmingham, UK.
authors.forename: M Thamara P R
authors.initials: MT
authors.lastname: Perera
authors.forename: Michael A
authors.initials: MA
authors.lastname: Silva
authors.forename: Bassem
authors.initials: B
authors.lastname: Hegab
authors.forename: Vijayaragavan
authors.initials: V
authors.lastname: Muralidharan
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: A David
authors.initials: AD
authors.lastname: Mayer
authors.forename: John A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017734:Bile Ducts, Extrahepatic / Q000293:injuries* / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D042241:Early Diagnosis; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012017:Referral and Consultation; D013043:Specialties, Surgical; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult