Bile Duct Injuries Associated With 55,134 Cholecystectomies: Treatment and Outcome from a National Perspective
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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.
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.
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).
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.
The authors wish to thank Anna Callmer and Nils Roubert who contributed by collecting and analyzing data from medical records of patients from the southern region of Sweden as part of the essay for their medical degree.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
This research was funded by Lund University, Region Skåne, grants from Eric and Angelicas Sparres Research foundation, Helge B Wulffs Research foundation, Professor Anders Borgströms Fellowship, and a travel grant from the Olympus Corporation.
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