 |
|
Devastating and Fatal Complications Associated With Combined Vascular and Bile Duct Injuries During Cholecystectomy
Joseph F. Buell, MD;
David C. Cronin, MD, PhD;
Brian Funaki, MD;
Alan Koffron, MD;
Atsushi Yoshida, MD;
Agnes Lo, PharmD;
Jeffery Leef, MD;
J. Michael Millis, MD
Arch Surg. 2002;137:703-710.
Hypothesis Multiple centers have reported on bile duct injuries after cholecystectomy, but few have reported on the impact of concomitant vascular injuries.
Design Twenty-seven life-threatening complex injuries (CIs) (Bismuth level III, IV, or V or combined arterial-ductal injuries) were retrospectively compared with 22 noncomplex injuries (NCs) (level I or II).
Setting Tertiary referral center.
Main Outcome Measures The incidence and level of biliary and arterial injuries and their resulting morbidity and mortality.
Results Bismuth classifications of all injuries were as follows: level I in 6 patients (12%), II in 19 (39%), III in 12 (24%), IV in 8 (16%), and V in 4 (8%). Diagnosis was based on peritonitis (n = 13 [27%]), endoscopic retrograde pancreatography (n = 19 [39%]), and percutaneous transhepatic cholangiography (n = 7 [14%]). Delayed referral was more common in levels I through IV (100 days) than in level V (15 days) (P<.001). Repairs were attempted in level IV (75%), III (67%), V (25%), and II (11%). Thirteen arterial injuries (26%) occurred irrespective of ductal injury level: I (n = 1), II (n = 3), III (n = 1), IV (n = 5), and V (n = 3). There was, however, a higher incidence of repairs before referral in the CI group (59% vs 5%; P<.01), with resulting higher rates of complication (70% vs 23%; P<.01). Five deaths occurred in the CI group vs 1 in the NC group (P = .14). In univariate analysis, the presence of arterial injury vs no arterial injury was a predictor of mortality (5 [38%] of 13 patients vs 1 [3%] of 36 patients; P<.001).
Conclusion Bile duct injuries after cholecystectomy can be morbid and lethal with the incidence of arterial injury grossly underestimated.
From the Departments of Surgery and Radiology, Section of Transplantation, the University of Chicago, Pritzker School of Medicine, Chicago, Ill. Dr Buell is now with the Division of Transplantation, University of Cincinnati, Cincinnati, Ohio.
RELATED ARTICLE
This Month in Archives of Surgery
Arch Surg. 2002;137(6):638.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Minimally invasive surgery
Jaffray
Arch. Dis. Child. 2005;90:537-542.
ABSTRACT
| FULL TEXT
|
