title: Bile duct reconstruction following laparoscopic cholecystectomy in England.
abstract: To determine the incidence of bile duct reconstruction (BDR) following laparoscopic cholecystectomy (LC) and to identify associated risk factors.
  
  
  
  Major bile duct injury (BDI) requiring reconstruction is a serious complication of cholecystectomy.
  
  
  
  All LC and attempted LC operations in England between April 2001 and March 2013 were identified. Patients with malignancy, a stone in bile duct or those who underwent bile duct exploration were excluded. This cohort of patients was followed for 1 year to identify those who underwent BDR as a surrogate marker for major BDI. Logistic regression was used to identify factors associated with the need for reconstruction.
  
  
  
  In total, 572,223 LC and attempted LC were performed in England between April 2001 and March 2013. Five hundred (0.09 %) of these patients underwent BDR. The risk of BDR is lower in patient that do not have acute cholecystitis [odds ratio (OR) 0.48 (95 % CI 0.30-0.76)]. The regular use of on-table cholangiography (OTC) [OR 0.69 (0.54-0.88)] and high consultant caseload >80 LC/year [OR 0.56 (0.39-0.54)] reduced the risk of BDR. Patients who underwent BDR were 10 times more likely to die within a year than those who did not require further surgery (6 vs. 0.6 %).
  
  
  
  The rate of BDR following laparoscopic cholecystectomy in England is low (0.09 %). The study suggests that OTC should be used more widely and provides further evidence in support of the provision of LC services by specialised teams with an adequate caseload (>80).
authors.affiliation: The Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: El-Dhuwaib
authors.affiliation: The Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK.|Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK.
authors.forename: J
authors.initials: J
authors.lastname: Slavin
authors.affiliation: Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Corless
authors.affiliation: Health Informatics Department, University Hospitals Birmingham, Birmingham, UK.
authors.forename: I
authors.initials: I
authors.lastname: Begaj
authors.affiliation: Department of Surgery, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6RG, UK.
authors.forename: D
authors.initials: D
authors.lastname: Durkin
authors.affiliation: The Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK. Mark.Deakin@uhns.nhs.uk.|Department of Surgery, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6RG, UK. Mark.Deakin@uhns.nhs.uk.
authors.forename: M
authors.initials: M
authors.lastname: Deakin
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002764:Cholecystitis / Q000150:complications; D004739:England; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: Bile duct injury; Bile duct reconstruction; Hospital Episode Statistics data; Laparoscopic cholecystectomy; On-table cholangiography
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