Improved Outcomes of Bile Duct Injuries in the 21st Century

Abstract

Almost all bile leaks and many bile duct injuries can be managed successfully by endoscopists. Selected proximal injuries can be treated by interventional radiologists with modest success. Outcomes of bile duct injuries are best with surgical management and in patients who are stented for more than 6 months.

Bile Duct Injuries Following Laparoscopic Cholecystectomy and their Outcome

“…Whether drainage should be performed percutaneously or endoscopically is, however, still debated (11,27) . In our series, most patients could be treated with endoscopic procedures, which was also the conclusion in a paper by Pittet al (28) . In conclusion, bile duct injuries are relatively uncommon following laparoscopic cholecystectomy.…”

Surgical management of post-cholecystectomy bile duct injuries: referral patterns and factors influencing early and long-term outcome

“…Furthermore, surgery needs to be properly integrated with operative endoscopy and interventional radiology. The availability of skilled interventional radiologists capable of performing difficult percutaneous drainages and dealing with nondilated biliary systems is fundamental [19][20][21][22]. In our series, only two patients required laparotomy to control abdominal sepsis prior to definitive repair, whereas all the others were successfully managed by percutaneous drainage and transhepatic biliary drainage.…”

Proposal for Standardized Tabular Reporting of Observational Surgical Studies Illustrated in a Study on Primary Repair of Bile Duct Injuries

“…Pitt and colleagues 2 considered "failure" as the need for therapeutic intervention post-repair or stent retention for greater than 15 months. 2 A "rare" attack of cholangitis was not considered failure. 2 McDonald and associates 27 described a 4-level classification that included evaluation of postoperative liver function tests as well as cholangitis and interventions, but not duration of postoperative stent retention.…”

“…This subject is very suitable for this paper because as previously noted, it is difficult to compare studies on this topic because of the variations in reporting methodology. 2,4 …”

“…Results of repair have improved with time. [2][3][4] The desirability of comparing and perhaps synthesizing results over time and among centers is obvious. This subject is very suitable for this paper because as previously noted, it is difficult to compare studies on this topic because of the variations in reporting methodology.…”