title: Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Cystic duct and Luschka duct leakage after laparoscopic cholecystectomy are often classified as minor injuries because the outcome of endoscopic stenting and percutaneous drainage is generally reported to be good. However, the potential associated early mortality and risk factors for mortality are scarcely reported. The aim of this study was to describe the outcome, mortality, and risk factors for poor survival of patients with type A bile duct injury (BDI) referred to a tertiary center.
  
  
  METHODS
  Between January 1990 and January 2012, 800 patients were referred for BDI treatment and included in a prospective database.
  
  
  RESULTS
  Type A BDI, according to the Amsterdam and Strasberg classifications, was diagnosed in 216 patients. Treatment after referral was mainly endoscopic (n = 192 [88.9 %]) and radiologic (n = 14 [6.5 %]). Complications related to endoscopic retrograde cholangiopancreatography (ERCP) occurred in 14 patients (6.5 %). Other complications were sepsis (n = 34 [15.7 %]), cardiopulmonary (n = 22 [10.2 %]), and abscess formation (n = 15 [6.9 %]). BDI-related mortality was 4.2 % (9/216). Multivariate analysis showed age (hazard ratio [HR] = 1.04, 95 % confidence interval [CI] 1.00 - 1.07) and American Society of Anesthesiologists class 3 or 4 (HR = 5.64, 95 %CI 2.31 - 13.77) to be independent factors significantly associated with mortality.
  
  
  CONCLUSIONS
  Type A "minor" BDI after laparoscopic cholecystectomy is associated with considerable short-term mortality related to the patient's condition at referral. Older patients and patients with ASA 3 or 4 have a significantly higher risk of mortality.
authors.affiliation: Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Klaske A C
authors.initials: KA
authors.lastname: Booij
authors.affiliation: Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Philip R
authors.initials: PR
authors.lastname: de Reuver
authors.affiliation: Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Yap
authors.affiliation: Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: van Dieren
authors.affiliation: Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Otto M
authors.initials: OM
authors.lastname: van Delden
authors.affiliation: Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Erik A
authors.initials: EA
authors.lastname: Rauws
authors.affiliation: Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003549:Cystic Duct / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome