Impact of iatrogenic post-cholecystectomy biliary duct injury on quantity of diagnostic imaging and hospital re-admission

Abstract

Although the risk of persistent biliary duct injury is low, cholecystectomy is one of the most commonly performed procedures worldwide. The occurrence of bile duct injury (BDI) results in complicated reconstructions, prolonged hospitalisation, repeated diagnostic examinations, and a high risk of long-term complications, leading to cost increase. A wide range of diagnostic methods are used to identify the damage and the associated complications. The aim of the study was to evaluate the impact of iatrogenic post-cholecystectomy BDI on the amount of diagnostic imaging and hospital re-admission rate. The retrospective cross-sectional study included the analysis of records of 38 patients undergoing laparoscopic cholecystectomy, referred to the Diagnostic Radiology Institute, Pauls Stradiņš Clinical University Hospital, who underwent diagnostic imaging. Among those who had iatrogenic BDI due to cholecystectomy, 57.9% (22 patients) underwent abdominal ultrasonography, 47.4% (18 patients) underwent endoscopic retrograde cholangiopancreatography, 47.4% (18 patients) underwent percutaneous transhepatic cholangiography (PTCA), 44.7% (17 patients) underwent computed tomography, 42.1% (16 patients) underwent magnetic resonance imaging, 13.2% (five patients) underwent US-guided puncture after cholecystectomy, and 15.8% (six patients) underwent fistulography. 18.4% (seven patients) were re-admitted to hospital once due to post-cholecystectomy complications, 34.2% (13 patients) twice, 15.8% (six patients) three times, 5.3% (two patients) four times, 13.2% (five patients) five times, 2.6% (one patient) seven times, 2.6% (one patient) ten times, 5.3% (two patients) eleven times and 2.6% (one patient) was re-admitted twenty-five times. Statistically significant strong correlation between hospital re-admission rate and PTCA (rs = 0.682, p < 0.001) was found. Iatrogenic post-cholecystectomy BDI significantly affects repeated diagnostic imaging and the hospital re-admission rate and, therefore, negatively affects hospital economics and patient welfare.