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Surg Endosc. 2016 Oct;30(10):4294-9. doi: 10.1007/s00464-016-4745-9. Epub 2016 Jan 28.

Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy.

Author information

1
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. caitlinannhalbert@gmail.com.
2
, 537 Stanton-Christiana Road, Suite 102, Newark, DE, 19713, USA. caitlinannhalbert@gmail.com.
3
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
4
Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
5
Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.

Abstract

INTRODUCTION:

Common bile duct (CBD) injury is a serious and dreaded complication of cholecystectomy. A paucity of data assessing long-term outcomes exists. This study aimed to determine long-term mortality and liver transplantation rates following CBD injury requiring operative intervention.

METHODS:

Patients were identified via the New York State (NYS) Planning and Research Cooperative System longitudinal administrative database which captures patient-level data from every inpatient and outpatient hospital discharge in NYS. In total, 125 patients with CBD injuries were identified following 156,958 laparoscopic cholecystectomies for cholelithiasis performed in NYS from 2005 to 2010. Patients were then tracked by unique identifier to obtain rate of liver transplantation. Follow-up ranged from 4 to 9 years from surgery.

RESULTS:

There were 125 patients with CBD injuries detected. No mortalities occurred within 30 days. All-cause mortality was 20.8 % (n = 26) with mean time to death 1.64 ± 1.08 years. One patient who underwent hepaticoenterostomy required a liver transplant 4.3 years after surgery. Significant factors predictive of all-cause mortality included: age >61, Medicare insurance, male gender, White race, diabetes, hypertension and pulmonary complications following surgery. Overall 30-day morbidity, timing to and type of operative intervention did not influence mortality.

CONCLUSION:

Considerable long-term mortality, 20.8 %, is associated with common bile duct injury requiring operative intervention. This was an increase of 8.8 % above the cohort's expected age-adjusted rate of death. The mortality rate is appreciably higher than quoted previously. No difference was demonstrated by type of repair required. Liver transplant rate was 0.8 %. These data have significant implications for patient and family counseling both prior to cholecystectomy and following CBD injury.

KEYWORDS:

Common bile duct injury; Laparoscopic cholecystectomy; Mortality; Transplant

PMID:
26823055
DOI:
10.1007/s00464-016-4745-9
[Indexed for MEDLINE]

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