Management of Laparoscopic Cholecystectomy-Related Bile Duct Injuries: A Tertiary Center Experience
Ramazan Saygin Kerimoglu1, Erdal Birol Bostanci1, Tahsin Dalgic1
1Turkiye Yuksek Ihtisas Teaching and Research Hospital, Department of Gastroenterological Surgery, Ankara, Turkey.
Background:
Laparoscopic cholecystectomy (LC)-related bile duct injuries remains a challenging issue with major implications for patient's outcome.
Methods:
Between January 2008 and December 2012, we retrospectively analyzed the management and treatment outcomes of 90 patients with bile duct injury following LC.
Results:
Forty-seven patients (52.2%) were treated surgically while the remaining 43 patients (47.8%) underwent non-surgical intervention. Injuries of Strasberg Type A and C were significantly more frequent in the non-surgical intervention group (P = 0.016, P = 0.044) whereas Type E2 was more frequent in the definitive surgery group (P < 0.001). The success rate of non-surgical intervention decreased as the waiting time increased whereas the success of definitive surgery was not time-dependent (P = 0.048). Initial jaundice (direct biluribin >1.3 gr/dL) significantly reduced the success rate of non-surgical interventions (P = 0.017). Presence of intraabdominal abscess significantly increased the complication rate after both definitive surgery and non-surgical interventions (P = 0.04, P = 0.023). Treatment success rates were similar in both surgery and non-surgical intervention groups according to the distribution of Strasberg injury types.
Conclusion:
A multimodality approach is recommended in planning for patient-based treatment. Delayed referral reduces the success of nonsurgical interventions while it does not seem to significantly affect the success of surgical interventions when intraabdominal sepsis is under control.
