Endoscopy 2015; 47(01): 40-46
DOI: 10.1055/s-0034-1390908
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy

Klaske A. C. Booij
1  Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
,
Philip R. de Reuver
1  Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
,
Kenneth Yap
1  Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
,
Susan van Dieren
2  Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
,
Otto M. van Delden
3  Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
,
Erik A. Rauws
4  Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
,
Dirk J. Gouma
1  Department of surgery, Academic Medical Centre, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 19 January 2014

accepted after revision 30 September 2014

Publication Date:
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.