Management of laparoscopic cholecystectomy-related bile ductinjuries: A tertiary center experience


Keiimoglu R. S. , Bostanci E. B. , Dalgic T., Karaman K., Kayapinar A. K. , Ozer L., ...More

Archives of Iranian Medicine, vol.20, no.8, pp.487-493, 2017 (Peer-Reviewed Journal) identifier identifier

  • Publication Type: Article / Article
  • Volume: 20 Issue: 8
  • Publication Date: 2017
  • Journal Name: Archives of Iranian Medicine
  • Journal Indexes: Science Citation Index Expanded, Scopus
  • Page Numbers: pp.487-493

Abstract

© 2017, Academy of Medical Sciences of I.R. Iran. All rights reserved.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.