HYPOTHESIS: Multiple centers have reported on bile duct injuries after cholecystectomy, but few have reported on the impact of concomitant vascular injuries. DESIGN: Twenty-seven life-threatening complex injuries (CIs) (Bismuth level III, IV, or V or combined arterial-ductal injuries) were retrospectively compared with 22 noncomplex injuries (NCs) (level I or II). SETTING: Tertiary referral center. MAIN OUTCOME MEASURES: The incidence and level of biliary and arterial injuries and their resulting morbidity and mortality. RESULTS: Bismuth classifications of all injuries were as follows: level I in 6 patients (12%), II in 19 (39%), III in 12 (24%), IV in 8 (16%), and V in 4 (8%). Diagnosis was based on peritonitis (n = 13 [27%]), endoscopic retrograde pancreatography (n = 19 [39%]), and percutaneous transhepatic cholangiography (n = 7 [14%]). Delayed referral was more common in levels I through IV (100 days) than in level V (15 days) (P<.001). Repairs were attempted in level IV (75%), III (67%), V (25%), and II (11%). Thirteen arterial injuries (26%) occurred irrespective of ductal injury level: I (n = 1), II (n = 3), III (n = 1), IV (n = 5), and V (n = 3). There was, however, a higher incidence of repairs before referral in the CI group (59% vs 5%; P<.01), with resulting higher rates of complication (70% vs 23%; P<.01). Five deaths occurred in the CI group vs 1 in the NC group (P =.14). In univariate analysis, the presence of arterial injury vs no arterial injury was a predictor of mortality (5 [38%] of 13 patients vs 1 [3%] of 36 patients; P<.001). CONCLUSION: Bile duct injuries after cholecystectomy can be morbid and lethal with the incidence of arterial injury grossly underestimated.
HYPOTHESIS: Multiple centers have reported on bile duct injuries after cholecystectomy, but few have reported on the impact of concomitant vascular injuries. DESIGN: Twenty-seven life-threatening complex injuries (CIs) (Bismuth level III, IV, or V or combined arterial-ductal injuries) were retrospectively compared with 22 noncomplex injuries (NCs) (level I or II). SETTING: Tertiary referral center. MAIN OUTCOME MEASURES: The incidence and level of biliary and arterial injuries and their resulting morbidity and mortality. RESULTS:Bismuth classifications of all injuries were as follows: level I in 6 patients (12%), II in 19 (39%), III in 12 (24%), IV in 8 (16%), and V in 4 (8%). Diagnosis was based on peritonitis (n = 13 [27%]), endoscopic retrograde pancreatography (n = 19 [39%]), and percutaneous transhepatic cholangiography (n = 7 [14%]). Delayed referral was more common in levels I through IV (100 days) than in level V (15 days) (P<.001). Repairs were attempted in level IV (75%), III (67%), V (25%), and II (11%). Thirteen arterial injuries (26%) occurred irrespective of ductal injury level: I (n = 1), II (n = 3), III (n = 1), IV (n = 5), and V (n = 3). There was, however, a higher incidence of repairs before referral in the CI group (59% vs 5%; P<.01), with resulting higher rates of complication (70% vs 23%; P<.01). Five deaths occurred in the CI group vs 1 in the NC group (P =.14). In univariate analysis, the presence of arterial injury vs no arterial injury was a predictor of mortality (5 [38%] of 13 patients vs 1 [3%] of 36 patients; P<.001). CONCLUSION: Bile duct injuries after cholecystectomy can be morbid and lethal with the incidence of arterial injury grossly underestimated.
Authors: P Gentileschi; M Di Paola; M Catarci; E Santoro; L Montemurro; M Carlini; E Nanni; L Alessandroni; R Angeloni; B Benini; F Cristini; A Dalla Torre; C De Stefano; A Gatto; F Gossetti; S Manfroni; P Mascagni; L Masoni; G Montalto; D Polito; E Puce; G Silecchia; A Terenzi; M Valle; S Vita; T Zanarini Journal: Surg Endosc Date: 2003-12-29 Impact factor: 4.584
Authors: Pablo Capitanich; Javier Herrera; Mario L Iovaldi; Roque Balbuena; Gabriel Casas; Patricio Malizia; Maximiliano Bun; Norberto Mezzadri Journal: J Gastrointest Surg Date: 2005-03 Impact factor: 3.452
Authors: Lucas McCormack; Emilio G Quiñonez; Pablo Capitanich; Sara Chao; Victor Serafini; Nicolas Goldaracena; Ricardo C Mastai Journal: Patient Saf Surg Date: 2009-09-15