title: Bile Duct Injuries Associated With 55,134 Cholecystectomies: Treatment and Outcome from a National Perspective.
abstract: BACKGROUND
  Bile duct injury (BDI) is a rare complication associated with cholecystectomy, and recommendations for treatment are based on publications from referral centers with a selection of major injuries and failures after primary repair. The aim was to analyze the frequency, treatment, and outcome of BDIs in an unselected population-based cohort.
  
  
  METHODS
  This was a retrospective cohort study including all BDIs registered in GallRiks (Swedish quality register for gallstone surgery and ERCP) during 2007-2011. Data for this study were based on a national follow-up survey where medical records were scrutinized and BDIs classified according to the Hannover classification.
  
  
  RESULTS
  A total of 174 BDIs arising from 55,134 cholecystectomies (0.3%) identified at 60 hospitals were included with a median follow-up of 37 months (9-69). 155 BDIs (89%) were detected during cholecystectomy, and immediate repair was attempted in 140 (90%). A total of 27 patients (18%) were referred to a HPB referral center. Hannover Grade C1 (i.e., small lesion <5 mm) dominated (n = 102; 59%). The most common repair was "suture over T-tube" (n = 78; 45%) and reconstruction with hepaticojejunostomy was performed in 30 patients (17%). A total of 31 patients (18 %) were diagnosed with stricture, 19 of which were primarily repaired with "suture over T-tube." The median in-hospital-stay was 14 days (1-149).
  
  
  CONCLUSIONS
  The majority of BDIs were detected during the cholecystectomy and repaired by the operating surgeon. Although this is against most current recommendations, short-term outcome was surprisingly good.
authors.affiliation: Department of Surgery, Clinical Sciences, Lund University, Lund, Sweden. jenny.rystedt@med.lu.se.|Department of Surgery, Skane University Hospital, 221 85, Lund, Sweden. jenny.rystedt@med.lu.se.
authors.forename: Jenny
authors.initials: J
authors.lastname: Rystedt
authors.affiliation: Department of Surgery, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Gert
authors.initials: G
authors.lastname: Lindell
authors.affiliation: Department of Surgery, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Montgomery
mesh_terms: D001652:Bile Ducts / Q000293:injuries*; D002763:Cholecystectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology