Bile duct injury repair —— earlier is not better.
Bile duct injury is a common complication of cholecystectomy. The timing of bile duct injury repair remains controversial. A recent review conducted in France reported 39% complications and 64% failure after immediate repair in 194 patients compared with 14% complications and 8%failure after late repair in 133 patients. A national review of 139 consecutive early repairs conducted at five hepatopancreaticobiliary centers in Denmark reported 4% mortality, 36% morbidity, and 42 restrictures (30%) at a median follow-up of 102 months, and only 64 patients (46%) demonstrated uneventful short-term and long-term outcomes. Most patients with bile duct injury present with bile leak and sepsis; thus, early repair is not recommended. Percutaneous drainage of bile and endoscopic stenting are the mainstays of treatment of bile leak because they convert acute bile duct injury into a controlled external biliary fistula. The ensuing benign biliary stricture should be repaired by a biliary surgeon after a delay of 4–6 weeks once the external biliary fistula has closed.
Vinay K
VK
Kapoor
D000368:Aged; D001652:Bile Ducts / Q000293:injuries / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012086:Reoperation / Q000379:methods*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome