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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Referral Pattern, Management, and Long-Term Results of Laparoscopic Bile Duct Injuries: A Case Series of 44 Patients

1
Department of Surgery, Medical Academy, Lithuanian University of Health Sciences
2
Institute for Research of Digestive System, Medical Academy, Lithuanian University of Health Sciences, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2012, 48(3), 19; https://doi.org/10.3390/medicina48030019
Received: 28 September 2011 / Accepted: 30 March 2012 / Published: 4 April 2012
Background and Objective. The incidence of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is higher than after open cholecystectomy, and the management of these lesions is still controversial. This study analyzed diagnostic and management strategies as well as long-term outcomes after BDI.
Material and Methods. A prospective database of patients with BDIs at the Clinic of Surgery was maintained during the 8-year period (2000–2007). The long-term results were evaluated during 2008–2010, after 36- to 120-month follow-up (median, 84 months).
Results
. In our series, 21 patients (48%) presented with minor and 23 (52%) with major BDIs. The overall incidence of BDIs was 0.24%. In 92% of cases in the minor BDI group, endoscopic stenting resulted in a good outcome. Major BDIs were treated by immediate, early, or delayed surgery depending on the timeliness of diagnosis and presence of biliary sepsis and/or cholangitis. The mean estimated time to failure after the initial treatment in the minor BDI group was significantly longer when compared with the major BDI group (114.3 vs. 81.8 months, log-rank test P=0.048). The hazard ratio of initial treatment failure after major versus minor BDIs was 6.06 (95% CI, 1.01–17.59). The mean estimated time to develop a biliary stricture after immediate, early, and delayed reconstructions was not different (P>0.05 in pairwise comparisons by log-rank test).
Conclusions
. Minor BDIs are best served by endoscopy, while surgical repair may be an efficient option when injury is diagnosed intraoperatively. The timing of reconstruction after major BDIs does not portend a different outcome; consequently, every attempt to achieve infection control should be warranted. Referral to a tertiary care center should be encouraged to facilitate a proper classification of preoperative injuries and multidisciplinary approach
Keywords: laparoscopic cholecystectomy; bile duct injury; management strategy; long-term results laparoscopic cholecystectomy; bile duct injury; management strategy; long-term results
MDPI and ACS Style

Barauskas, G.; Paškauskas, S.; Dambrauskas, Ž.; Gulbinas, A.; Pundzius, J. Referral Pattern, Management, and Long-Term Results of Laparoscopic Bile Duct Injuries: A Case Series of 44 Patients. Medicina 2012, 48, 19.

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