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.
