Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy
submitted 19 January 2014
accepted after revision 30 September 2014
22 December 2014 (online)
Background and study aims: Cystic duct and Luschka duct leakage after laparoscopic cholecystectomy are often classified as minor injuries because the outcome of endoscopic stenting and percutaneous drainage is generally reported to be good. However, the potential associated early mortality and risk factors for mortality are scarcely reported. The aim of this study was to describe the outcome, mortality, and risk factors for poor survival of patients with type A bile duct injury (BDI) referred to a tertiary center.
Patients and methods: Between January 1990 and January 2012, 800 patients were referred for BDI treatment and included in a prospective database.
Results: Type A BDI, according to the Amsterdam and Strasberg classifications, was diagnosed in 216 patients. Treatment after referral was mainly endoscopic (n = 192 [88.9 %]) and radiologic (n = 14 [6.5 %]). Complications related to endoscopic retrograde cholangiopancreatography (ERCP) occurred in 14 patients (6.5 %). Other complications were sepsis (n = 34 [15.7 %]), cardiopulmonary (n = 22 [10.2 %]), and abscess formation (n = 15 [6.9 %]). BDI-related mortality was 4.2 % (9/216). Multivariate analysis showed age (hazard ratio [HR] = 1.04, 95 % confidence interval [CI] 1.00 – 1.07) and American Society of Anesthesiologists class 3 or 4 (HR = 5.64, 95 %CI 2.31 – 13.77) to be independent factors significantly associated with mortality.
Conclusions: Type A “minor” BDI after laparoscopic cholecystectomy is associated with considerable short-term mortality related to the patient’s condition at referral. Older patients and patients with ASA 3 or 4 have a significantly higher risk of mortality.
- 1 Go PM, Schol F, Gouma DJ. Laparoscopic cholecystectomy in The Netherlands. Br J Surg 1993; 80: 1180-1183
- 2 Flum DR, Cheadle A, Prela C et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003; 290: 2168-2173
- 3 Gouma DJ, Rauws EA, Keulemans YC et al. Galwegletsel na laparoscopische cholecystectomie. Ned Tijdschr Geneeskd 1999; 143: 606-611
- 4 Dutch Surgical Society. Evidence based guideline. Evaluation and treatment of gallstones. 2007 Available from: http://www.heelkunde.nl/uploads/_6/re/_6reZZkgrYUAuCG6uvcN-A/richtlijn_galsteen.pdf
- 5 Massoumi H, Kiyici N, Hertan H. Bile leak after laparoscopic cholecystectomy. J Clin Gastroenterol 2007; 41: 301-305
- 6 Bergman JJ, van den Brink GR, Rauws EA et al. Treatment of bile duct lesions after laparoscopic cholecystectomy. Gut 1996; 38: 141-147
- 7 Strasberg SM, Hertl M, Soper NJ. Analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180: 101-125
- 8 McMahon AJ, Fullarton G, Baxter JN et al. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 1995; 82: 307-313
- 9 Singh V, Singh G, Verma GR et al. Endoscopic management of postcholecystectomy biliary leakage. Hepatobiliary Pancreat Dis Int 2010; 9: 409-413
- 10 Dolay K, Soylu A, Aygun E. The role of ERCP in the management of bile leakage: endoscopic sphincterotomy versus biliary stenting. J Laparoendosc Adv Surg Tech A 2010; 20: 455-459
- 11 Pitt HA, Sherman S, Johnson MS et al. Improved outcomes of bile duct injuries in the 21st century. Ann Surg 2013; 258: 490-499
- 12 de Reuver PR, Rauws EA, Bruno MJ et al. Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons. Surgery 2007; 142: 1-9
- 13 de Reuver PR, Rauws EA, Vermeulen M et al. Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success. Gut 2007; 56: 1599-1605
- 14 Tornqvist B, Stromberg C, Persson G et al. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 2012; 345: e6457
- 15 Sicklick JK, Camp MS, Lillemoe KD et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy in 200 patients. Ann Surg 2005; 241: 786-792
- 16 Harboe KM, Bardram L. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg Endosc 2011; 25: 1630-1641
- 17 Buddingh KT, Weersma RK, Savenije RA et al. Lower rate of major bile duct injury and increased intraoperative management of common bile duct stones after implementation of routine intraoperative cholangiography. J Am Coll Surg 2011; 213: 267-274
- 18 Booij KA, de Reuver PR, Nijsse B et al. Insufficient safety measures reported in operation notes of complicated laparoscopic cholecystectomies. Surgery 2014; 155: 384-389
- 19 Goshi T, Okamura S, Takeuchi H et al. Migrated endoclip and stone formation after cholecystectomy: a case treated by endoscopic sphincterotomy. Intern Med 2009; 48: 2015-2017
- 20 Ray S, Bhattacharya SP. Endoclip migration into the common bile duct with stone formation: a rare complication after laparoscopic cholecystectomy. JSLS 2013; 17: 330-332
- 21 Kortram K, de Vries ReilinghTS, Wiezer MJ et al. Percutaneous drainage for acute calculous cholecystitis. Surg Endosc 2011; 25: 3642-3646
- 22 Davis B, Castaneda G, Lopez J. Subtotal cholecystectomy versus total cholecystectomy in complicated cholecystitis. Am Surg 2012; 78: 814-817