Cholecystectomy associated vasculobiliary injuries: Incidence and impact on surgical repair outcomes

Bile duct injury with concomitant vascular injury is a common complication of cholecystectomy. The influence of concomitant vascular injury on the presentation and management of bile duct injury remains debatable. This study aimed to determine the incidence of concomitant vascular injury in patients with post-cholecystectomy bile duct injury and its impact on presentation and short-term outcomes following biliary repair.

This prospective study was done between November 2019 and December 2022. Patients presenting with post-cholecystectomy bile duct injury were investigated to detect vascular injury using computed tomography angiography. A comparative analysis of clinical presentation, and results of biliary reconstruction was performed on patients with and without concomitant vascular injury. McDonald criteria were used to grade the outcome of biliary reconstruction in these patients.

We studied 48 patients with bile duct injury of which 19 (39%) patients had concomitant vascular injury on imaging. Concomitant vascular injury was found in 87% and 42% of patients with Strasberg type 4 and type 3 injury, respectively. At presentation, the incidence of liver abscesses was significantly higher in patients with concomitant vascular injury. After two years of biliary repair, 75% of patients had McDonald Grade A status, irrespective of whether vascular injury was present.

Approximately 39% of patients with biliary injury had concomitant vascular injury. A higher grade of biliary injury was associated with increased chances of concomitant vascular injury. The presence of vascular injury did not correlate with increased operative morbidity, prolonged hospital stay, or inferior outcomes of delayed biliary repair.