title: Non-surgical treatment of post-surgical bile duct injury: clinical implications and outcomes.
abstract: OBJECTIVE
  To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).
  
  
  METHODS
  The study patients were enrolled from the pancreatobiliary units of a tertiary teaching hospital for the treatment of BDIs after hepatobiliary tract surgeries, excluding operations for liver transplantation and malignancies, from January 1999 to August 2010. A total of 5167 patients underwent operations, and 77 patients had BDIs following surgery. The primary end point was the treatment success rate according to different types of BDIs sustained using endoscopic or percutaneous hepatic approaches. The type of BDI was defined using one of the following diagnostic tools: endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography scan, and magnetic resonance cholangiography. Patients with a final diagnosis of BDI underwent endoscopic and/or percutaneous interventions for the treatment of bile leak and/or stricture if clinically indicated. Patient consent was obtained, and study approval was granted by the Institutional Review Board in accordance with the legal regulations of the Human Clinical Research Center at the Seoul National University Hospital in Seoul, South Korea.
  
  
  RESULTS
  A total of 77 patients were enrolled in the study. They were divided into three groups according to type of BDI. Among them, 55 patients (71%) underwent cholecystectomy. Thirty-six patients (47%) had bile leak only (type 1), 31 patients had biliary stricture only (type 2), and 10 patients had both bile leak and biliary stricture (type 3). Their initial treatment modalities were non-surgical. The success rate of non-surgical treatment in each group was as follows: BDI type 1: 94%; type 2: 71%; and type 3: 30%. Clinical parameters such as demographic factors, primary disease, operation method, type of operation, non-surgical treatment modalities, endoscopic procedure steps, type of BDI, time to diagnosis and treatment duration were evaluated to evaluate the prognostic factors affecting the success rate. The type of BDI was a statistically significant prognostic factor in determining the success rate of non-surgical treatment. In addition, a shorter time to diagnosis of BDI after the operation correlated significantly with higher success rates in the treatment of type 1 BDIs.
  
  
  CONCLUSIONS
  Endoscopic or percutaneous hepatic approaches can be used as an initial treatment in type 1 and 2 BDIs. However, surgical intervention is a treatment of choice in type 3 BDI.
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Young Ook
authors.initials: YO
authors.lastname: Eum
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Joo Kyung
authors.initials: JK
authors.lastname: Park
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Jaeyoung
authors.initials: J
authors.lastname: Chun
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Sang-Hyub
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Yong-Bum
authors.initials: YB
authors.lastname: Yoon
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Yoon
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.affiliation: Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea.
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D049448:Cholangiopancreatography, Magnetic Resonance; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic; D004106:Dilatation; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D015607:Stents; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bile duct; Biliary stricture.; Endoscopic retrograde cholangiography; Percutaneous transhepatic biliary drainage; Percutaneous transhepatic cholangiography