Cholecystectomy-related bile duct and vasculobiliary injuries.
BACKGROUND
Combined vasculobiliary injury is a serious complication of cholecystectomy. This study examined medium- to long-term outcomes after such injury.


METHODS
Patients referred to this institution with Strasberg type E bile duct injuries were identified from a prospectively maintained database (1990-2010). Long-term outcomes were evaluated by chart review.


RESULTS
Sixty-three patients were referred with bile duct injury alone (45 patients) or vasculobiliary injury (18). Thirty patients (48 per cent) had septic complications before transfer. Twenty-six patients (41 per cent) had long-term biliary complications over a median follow-up of 96 (range 12-245) months. Nine patients (3 with bile duct injury, 6 with vasculobiliary injury) required further interventions after a median of 22 (8-38) months; five required biliary surgical revision and four percutaneous dilatation of biliary strictures. Vasculobiliary injury and injury-related sepsis were independent risk factors for treatment failure: hazard ratio 7·79 (95 per cent confidence interval 2·80 to 21·70; P < 0·001) and 4·82 (1·69 to 13·68; P = 0·003) respectively.


CONCLUSIONS
Outcome following bile duct injury repair was worse in patients with concomitant vasculobiliary injury and/or sepsis.
North Western Hepatobiliary Unit, University Hospital Aintree, Liverpool L7 9AL, UK.
G
G
Sarno
A A
AA
Al-Sarira
P
P
Ghaneh
S W
SW
Fenwick
H Z
HZ
Malik
G J
GJ
Poston
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries*; D002763:Cholecystectomy / Q000009:adverse effects*; D005260:Female; D006499:Hepatic Artery / Q000293:injuries; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D055815:Young Adult