title: The influence of time referral in the treatment of iatrogenic lesions of biliary tract.
abstract: OBJECTIVE
  To evaluate the prognosis of patients with iatrogenic bile duct injury (IBDI) regarding time of referral (RT) to the unit of liver transplantation (LT).
  
  
  METHODS
  We reviewed 51 charts of patients who had suffered some kind of IBDI during cholecystectomy and who were referred to the Bonsucesso General Hospital (HGB) LT unit. Lesions were grouped according to the Bismuth classification. Besides cholecystectomy (time of injury), we also evaluated the RT and outcome.
  
  
  RESULTS
  Among the 51 patients studied, there were 17 men and 34 women, with a mean age of 42.7 years. Twenty-two patients (43.1%) had a type II lesion, 13 (25.5%) type III, 10 (19.6%) type I, 5 (9.8%) type IV and only 1 (2%) type V. Forty patients were operated, and three did not return for medical review, therefore, 37 were evaluated in relation to outcome. Among these, 25 patients (67.6%) had excellent or good results with average RT of 11.5 months (range: 2-48 months) and 47.2 months (range: 3-180 months) respectively. The 12 patients (32.4%) with poor results had a mean RT of 65.9 months (range: 3 264 months), which was significantly higher than the group with excellent or good results (p=0.004). Seven patients were listed for LT, but only two were transplanted. The RT of these seven patients was significantly higher (p=0.04) than those patients not listed. Seven patients died, six of which were due to liver complications.
  
  
  CONCLUSIONS
  RT significantly influenced the prognosis of patients in our sample.
authors.affiliation: Hospital Geral de Bonsucesso, Rio de Janeiro-RJ, Brazil. barroscirurgia@gmail.com
authors.forename: Fernando
authors.initials: F
authors.lastname: Barros
authors.forename: Reinaldo Afonso
authors.initials: RA
authors.lastname: Fernandes
authors.forename: Marcelo Enne
authors.initials: ME
authors.lastname: de Oliveira
authors.forename: Lúcio Filgueiras
authors.initials: LF
authors.lastname: Pacheco
authors.forename: José Manoel da Silva G
authors.initials: JM
authors.lastname: Martinho
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000293:injuries*; D002763:Cholecystectomy; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors