title: Risk factors for development of biliary stricture in patients presenting with bile leak after cholecystectomy.
abstract: OBJECTIVE
  This study was aimed at determining the factors associated with the development of benign biliary stricture (BBS) in patients who had sustained a bile duct injury (BDI) at cholecystectomy and developed bile leaks.
  
  
  METHODS
  A retrospective analysis of 214 patients with BDI who were referred to our center between January 1989 and December 2009 was done.
  
  
  RESULTS
  One hundred fifty-three (71%) patients developed BBS (group I), and 61 (29%) were normal (group II). By univariate analysis, female gender (p=0.02), open cholecystectomy as the index operation (p=0.0001), delay in the referral from identification of injury (p=0.04), persistence of an external biliary fistula (EBF) beyond 4 weeks (p=0.0001), EBF output >400 mL (p=0.01), presence of jaundice (p=0.0001), raised serum total bilirubin level (p=0.0001), raised serum alkaline phosphatase level (p=0.0001), and complete BDI (p=0.0001) were associated with the development of BBS. Furthermore, open cholecystectomy as the index operation (p=0.04), delayed referral (p=0.02), persistent EBF (p=0.03), and complete BDI (p=0.001) were found to predict patient outcome in the multivariate analysis.
  
  
  CONCLUSIONS
  For the majority of patients with BDI, the risk of developing BBS could have been predicted at the initial presentation.
authors.affiliation: Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Hosur Mayanna
authors.initials: HM
authors.lastname: Lokesh
authors.forename: Biju
authors.initials: B
authors.lastname: Pottakkat
authors.forename: Anand
authors.initials: A
authors.lastname: Prakash
authors.forename: Rajneesh Kumar
authors.initials: RK
authors.lastname: Singh
authors.forename: Anu
authors.initials: A
authors.lastname: Behari
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Kapoor
authors.forename: Rajan
authors.initials: R
authors.lastname: Saxena
keywords: Bile ducts; Cholecystectomy; Injuries