Bile Duct Injuries Should Be Repaired Immediately

Most laparoscopic cholecystectomy-associated bile duct injuries (LC-BDIs) should be repaired within 3 days at most at a tertiary hepatobiliary center, exhorts a new study.

Researchers at Toronto General Hospital (TGH; Canada) and the University of Wisconsin (UWM; Milwaukee, USA) conducted a retrospective medical record review of 69 patients who underwent surgical repair of LC-BDI between January 1, 1992, and December 31, 2007. The main outcome measures were the results following repair of LC-BDI, and the relationship between timing of LC-BDI repair and the outcomes, complications, and long-term results following LC-BDI repair. Univariate statistical analysis was used to identify risk factors for postoperative complications.

The results showed that 13 patients (19%) had immediate repair (i.e., within 72 hours after cholecystectomy), 34 (49%) had repair between 3 days and 6 weeks afterward, and 22 (32%) had late repair (after 6 weeks).

The most common long-term complication was biliary stricture, which occurred in 10 patients (14%). The researchers found that patients whose BDIs were repaired in the intermediate period were more likely to develop biliary stricture than patients with repairs performed in the immediate or late periods, as did the presence of preoperative bile leak. The researchers explained that bile contamination in the peritoneal cavity could be linked to inflammation in the surgical bed and ultimately to biliary strictures, and that acute inflammation related to the recent cholecystectomy would be maximal during the intermediate period. The study was published in the August 2010 issue of Archives of Surgery.

"Even though laparoscopic cholecystectomy has a slightly higher risk of bile duct injury than open surgery, it is still considered the better option,” said lead author Alice Wei, M.D., of TGH. "The keys to success are to be aware of patient anatomy or previous abdominal disease that may make the procedure more complicated, and to remain alert to injuries that might occur so they can be repaired as quickly as possible.”

"A major factor bedeviling management and optimal repair is that most bile duct injuries are not recognized during the laparoscopic cholecystectomy and only present later, by which time the patient may be septic with infected bile collections, cholangitis, hypoalbuminemia, and jaundice,” commented in the same issue Delawir Kahn, M.D., of the University of Cape Town Health Sciences Faculty (South Africa).

Related Links:
Toronto General Hospital
University of Wisconsin
University of Cape Town Health Sciences Faculty