Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: Perioperotive results in 200 patients

Jason K. Sicklick, Melissa Camp, Keith D. Lillemoe, Genevieve B. Melton, Charles J. Yeo, Kurtis A. Campbell, Mark A. Talamini, Henry A. Pitt, JoAnn Coleman, Patricia A. Sauter, John L Cameron, Selwyn M. Vickers, Reid B. Adams, A. Osama Gaber, Thomas R. Gadacz, Joseph B. Cofer

Research output: Contribution to journalArticle

Abstract

Objective: A single institution retrospective analysis of 200 patients with major bile duct injuries was completed. Three patients died without surgery due to uncontrolled sepsis. One hundred seventy-five patients underwent surgical repair, with a 1.7% postoperative mortality and a complication rate of 42.9%. Summary Background Data: The widespread application of laparoscopic cholecystectomy (LC) has led to a rise in the incidence of major bile duct injuries (BDI). Despite the frequency of these injuries and their complex management, the published literature contains few substantial reports regarding the perioperative management of BDI. Methods: From January 1990 to April 2003, a prospective database of all patients with a BDI following LC was maintained. Patients' charts were retrospectively reviewed to analyze perioperative surgical management. Results: Over 13 years, 200 patients were treated for a major BDI following LC. Patient demographics were notable for 150 women (75%) with a mean age of 45.5 years (median 44 years). One hundred eighty-eight sustained their BDI at an outside hospital. The mean interval from the time of BDI to referral was 29.1 weeks (median 3 weeks). One hundred nine patients (58%) were referred within 1 month of their injury for acute complications including bile leak, biloma, or jaundice. Twenty-five patients did not undergo a surgical repair at our institution. Three patients (1.5%) died after delayed referral before an attempt at repair due to uncontrolled sepsis. Twenty-two patients, having intact biliary-enteric continuity, underwent successful balloon dilatation of an anastomotic stricture. A total of 175 patients underwent definitive biliary reconstruction, including 172 hepaticojejunostomies (98%) and 3 end-to-end repairs. There were 3 deaths in the postoperative period (1.7%). Seventy-five patients (42.9%) sustained at least 1 postoperative complication. The most common complications were wound infection (8%), cholangitis (5.7%), and intraabdominal abscess/biloma (2.9%). Minor biliary stent complications occurred in 5.7% of patients. Early postoperative cholangiography revealed an anastomotic leak in 4.6% of patients and extravasation at the liver domestent exit site in 10.3% of patients. Postoperative interventions included percutaneous abscess drainage in 9 patients (5.1%) and new percutaneous transhepatic cholangiography and stent placement in 4 patients (2.3%). No patient required reoperation in the postoperative period. The mean postoperative length of stay was 9.5 days (median 9 days). The timing of operation (early, intermediate, delayed), presenting symptoms, and history of prior repair did not affect the incidence of the most common perioperative complications or length of postoperative hospital stay. Conclusions: This series represents the largest single institution experience reporting the perioperative management of BDI following LC. Although perioperative complications are frequent, nearly all can be managed nonoperatively. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

Original languageEnglish (US)
Pages (from-to)786-795
Number of pages10
JournalAnnals of Surgery
Volume241
Issue number5
DOIs
StatePublished - May 2005

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Laparoscopic Cholecystectomy
Bile Ducts
Wounds and Injuries
Referral and Consultation
Cholangiography
Postoperative Period
Abscess
Stents
Length of Stay
Sepsis
Anastomotic Leak
Cholangitis
Incidence

ASJC Scopus subject areas

  • Surgery

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Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy : Perioperotive results in 200 patients. / Sicklick, Jason K.; Camp, Melissa; Lillemoe, Keith D.; Melton, Genevieve B.; Yeo, Charles J.; Campbell, Kurtis A.; Talamini, Mark A.; Pitt, Henry A.; Coleman, JoAnn; Sauter, Patricia A.; Cameron, John L; Vickers, Selwyn M.; Adams, Reid B.; Gaber, A. Osama; Gadacz, Thomas R.; Cofer, Joseph B.

In: Annals of Surgery, Vol. 241, No. 5, 05.2005, p. 786-795.

Research output: Contribution to journalArticle

Sicklick, JK, Camp, M, Lillemoe, KD, Melton, GB, Yeo, CJ, Campbell, KA, Talamini, MA, Pitt, HA, Coleman, J, Sauter, PA, Cameron, JL, Vickers, SM, Adams, RB, Gaber, AO, Gadacz, TR & Cofer, JB 2005, 'Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: Perioperotive results in 200 patients', Annals of Surgery, vol. 241, no. 5, pp. 786-795. https://doi.org/10.1097/01.sla.0000161029.27410.71
Sicklick, Jason K. ; Camp, Melissa ; Lillemoe, Keith D. ; Melton, Genevieve B. ; Yeo, Charles J. ; Campbell, Kurtis A. ; Talamini, Mark A. ; Pitt, Henry A. ; Coleman, JoAnn ; Sauter, Patricia A. ; Cameron, John L ; Vickers, Selwyn M. ; Adams, Reid B. ; Gaber, A. Osama ; Gadacz, Thomas R. ; Cofer, Joseph B. / Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy : Perioperotive results in 200 patients. In: Annals of Surgery. 2005 ; Vol. 241, No. 5. pp. 786-795.
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abstract = "Objective: A single institution retrospective analysis of 200 patients with major bile duct injuries was completed. Three patients died without surgery due to uncontrolled sepsis. One hundred seventy-five patients underwent surgical repair, with a 1.7{\%} postoperative mortality and a complication rate of 42.9{\%}. Summary Background Data: The widespread application of laparoscopic cholecystectomy (LC) has led to a rise in the incidence of major bile duct injuries (BDI). Despite the frequency of these injuries and their complex management, the published literature contains few substantial reports regarding the perioperative management of BDI. Methods: From January 1990 to April 2003, a prospective database of all patients with a BDI following LC was maintained. Patients' charts were retrospectively reviewed to analyze perioperative surgical management. Results: Over 13 years, 200 patients were treated for a major BDI following LC. Patient demographics were notable for 150 women (75{\%}) with a mean age of 45.5 years (median 44 years). One hundred eighty-eight sustained their BDI at an outside hospital. The mean interval from the time of BDI to referral was 29.1 weeks (median 3 weeks). One hundred nine patients (58{\%}) were referred within 1 month of their injury for acute complications including bile leak, biloma, or jaundice. Twenty-five patients did not undergo a surgical repair at our institution. Three patients (1.5{\%}) died after delayed referral before an attempt at repair due to uncontrolled sepsis. Twenty-two patients, having intact biliary-enteric continuity, underwent successful balloon dilatation of an anastomotic stricture. A total of 175 patients underwent definitive biliary reconstruction, including 172 hepaticojejunostomies (98{\%}) and 3 end-to-end repairs. There were 3 deaths in the postoperative period (1.7{\%}). Seventy-five patients (42.9{\%}) sustained at least 1 postoperative complication. The most common complications were wound infection (8{\%}), cholangitis (5.7{\%}), and intraabdominal abscess/biloma (2.9{\%}). Minor biliary stent complications occurred in 5.7{\%} of patients. Early postoperative cholangiography revealed an anastomotic leak in 4.6{\%} of patients and extravasation at the liver domestent exit site in 10.3{\%} of patients. Postoperative interventions included percutaneous abscess drainage in 9 patients (5.1{\%}) and new percutaneous transhepatic cholangiography and stent placement in 4 patients (2.3{\%}). No patient required reoperation in the postoperative period. The mean postoperative length of stay was 9.5 days (median 9 days). The timing of operation (early, intermediate, delayed), presenting symptoms, and history of prior repair did not affect the incidence of the most common perioperative complications or length of postoperative hospital stay. Conclusions: This series represents the largest single institution experience reporting the perioperative management of BDI following LC. Although perioperative complications are frequent, nearly all can be managed nonoperatively. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.",
author = "Sicklick, {Jason K.} and Melissa Camp and Lillemoe, {Keith D.} and Melton, {Genevieve B.} and Yeo, {Charles J.} and Campbell, {Kurtis A.} and Talamini, {Mark A.} and Pitt, {Henry A.} and JoAnn Coleman and Sauter, {Patricia A.} and Cameron, {John L} and Vickers, {Selwyn M.} and Adams, {Reid B.} and Gaber, {A. Osama} and Gadacz, {Thomas R.} and Cofer, {Joseph B.}",
year = "2005",
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TY - JOUR

T1 - Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy

T2 - Perioperotive results in 200 patients

AU - Sicklick, Jason K.

AU - Camp, Melissa

AU - Lillemoe, Keith D.

AU - Melton, Genevieve B.

AU - Yeo, Charles J.

AU - Campbell, Kurtis A.

AU - Talamini, Mark A.

AU - Pitt, Henry A.

AU - Coleman, JoAnn

AU - Sauter, Patricia A.

AU - Cameron, John L

AU - Vickers, Selwyn M.

AU - Adams, Reid B.

AU - Gaber, A. Osama

AU - Gadacz, Thomas R.

AU - Cofer, Joseph B.

PY - 2005/5

Y1 - 2005/5

N2 - Objective: A single institution retrospective analysis of 200 patients with major bile duct injuries was completed. Three patients died without surgery due to uncontrolled sepsis. One hundred seventy-five patients underwent surgical repair, with a 1.7% postoperative mortality and a complication rate of 42.9%. Summary Background Data: The widespread application of laparoscopic cholecystectomy (LC) has led to a rise in the incidence of major bile duct injuries (BDI). Despite the frequency of these injuries and their complex management, the published literature contains few substantial reports regarding the perioperative management of BDI. Methods: From January 1990 to April 2003, a prospective database of all patients with a BDI following LC was maintained. Patients' charts were retrospectively reviewed to analyze perioperative surgical management. Results: Over 13 years, 200 patients were treated for a major BDI following LC. Patient demographics were notable for 150 women (75%) with a mean age of 45.5 years (median 44 years). One hundred eighty-eight sustained their BDI at an outside hospital. The mean interval from the time of BDI to referral was 29.1 weeks (median 3 weeks). One hundred nine patients (58%) were referred within 1 month of their injury for acute complications including bile leak, biloma, or jaundice. Twenty-five patients did not undergo a surgical repair at our institution. Three patients (1.5%) died after delayed referral before an attempt at repair due to uncontrolled sepsis. Twenty-two patients, having intact biliary-enteric continuity, underwent successful balloon dilatation of an anastomotic stricture. A total of 175 patients underwent definitive biliary reconstruction, including 172 hepaticojejunostomies (98%) and 3 end-to-end repairs. There were 3 deaths in the postoperative period (1.7%). Seventy-five patients (42.9%) sustained at least 1 postoperative complication. The most common complications were wound infection (8%), cholangitis (5.7%), and intraabdominal abscess/biloma (2.9%). Minor biliary stent complications occurred in 5.7% of patients. Early postoperative cholangiography revealed an anastomotic leak in 4.6% of patients and extravasation at the liver domestent exit site in 10.3% of patients. Postoperative interventions included percutaneous abscess drainage in 9 patients (5.1%) and new percutaneous transhepatic cholangiography and stent placement in 4 patients (2.3%). No patient required reoperation in the postoperative period. The mean postoperative length of stay was 9.5 days (median 9 days). The timing of operation (early, intermediate, delayed), presenting symptoms, and history of prior repair did not affect the incidence of the most common perioperative complications or length of postoperative hospital stay. Conclusions: This series represents the largest single institution experience reporting the perioperative management of BDI following LC. Although perioperative complications are frequent, nearly all can be managed nonoperatively. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

AB - Objective: A single institution retrospective analysis of 200 patients with major bile duct injuries was completed. Three patients died without surgery due to uncontrolled sepsis. One hundred seventy-five patients underwent surgical repair, with a 1.7% postoperative mortality and a complication rate of 42.9%. Summary Background Data: The widespread application of laparoscopic cholecystectomy (LC) has led to a rise in the incidence of major bile duct injuries (BDI). Despite the frequency of these injuries and their complex management, the published literature contains few substantial reports regarding the perioperative management of BDI. Methods: From January 1990 to April 2003, a prospective database of all patients with a BDI following LC was maintained. Patients' charts were retrospectively reviewed to analyze perioperative surgical management. Results: Over 13 years, 200 patients were treated for a major BDI following LC. Patient demographics were notable for 150 women (75%) with a mean age of 45.5 years (median 44 years). One hundred eighty-eight sustained their BDI at an outside hospital. The mean interval from the time of BDI to referral was 29.1 weeks (median 3 weeks). One hundred nine patients (58%) were referred within 1 month of their injury for acute complications including bile leak, biloma, or jaundice. Twenty-five patients did not undergo a surgical repair at our institution. Three patients (1.5%) died after delayed referral before an attempt at repair due to uncontrolled sepsis. Twenty-two patients, having intact biliary-enteric continuity, underwent successful balloon dilatation of an anastomotic stricture. A total of 175 patients underwent definitive biliary reconstruction, including 172 hepaticojejunostomies (98%) and 3 end-to-end repairs. There were 3 deaths in the postoperative period (1.7%). Seventy-five patients (42.9%) sustained at least 1 postoperative complication. The most common complications were wound infection (8%), cholangitis (5.7%), and intraabdominal abscess/biloma (2.9%). Minor biliary stent complications occurred in 5.7% of patients. Early postoperative cholangiography revealed an anastomotic leak in 4.6% of patients and extravasation at the liver domestent exit site in 10.3% of patients. Postoperative interventions included percutaneous abscess drainage in 9 patients (5.1%) and new percutaneous transhepatic cholangiography and stent placement in 4 patients (2.3%). No patient required reoperation in the postoperative period. The mean postoperative length of stay was 9.5 days (median 9 days). The timing of operation (early, intermediate, delayed), presenting symptoms, and history of prior repair did not affect the incidence of the most common perioperative complications or length of postoperative hospital stay. Conclusions: This series represents the largest single institution experience reporting the perioperative management of BDI following LC. Although perioperative complications are frequent, nearly all can be managed nonoperatively. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

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