Published in:
01-01-2016 | Original Scientific Report
Bile Duct Injuries Associated With 55,134 Cholecystectomies: Treatment and Outcome from a National Perspective
Published in: World Journal of Surgery | Issue 1/2016
Login to get accessAbstract
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.