Bile duct injuries associated with laparoscopic cholecystectomy: timing of repair and long-term outcomes.

OBJECTIVES To report on a large experience with laparoscopic cholecystectomy-associated bile duct injuries (LC-BDIs) and examine factors influencing outcomes. DESIGN A retrospective medical record review. Univariate statistical analysis was used to identify risk factors for postoperative complications. SETTING Two university-affiliated hospitals. PATIENTS Sixty-nine patients who underwent surgical repair of LC-BDI between January 1, 1992, and December 31, 2007. MAIN OUTCOME MEASURES Outcomes following repair of LC-BDI, relationship between timing of LC-BDI repair and outcomes, complications, and long-term results following LC-BDI repair. RESULTS Thirteen immediate repairs (0-72 hours post-LC), 34 intermediate repairs (72 hours-6 weeks), and 22 late repairs (>6 weeks) were performed. The LC-BDIs were Strasberg type A in 1 patient (1%), D in 2 patients (3%), E1 in 22 patients (32%), E2 in 16 patients (23%), E3 in 22 patients (32%), E4 in 4 patients (6%), and E5 in 2 patients (3%). Forty-one hepaticojejunostomies (59%), 24 choledochojejunostomies (35%), 3 right hepatic hepatectomies with biliary reconstruction (4%), and 1 primary common bile duct repair (1%) were performed. The overall morbidity rate was 30% (21 patients). The mortality rate was 1% (1 patient). Twelve patients (17%) developed short-term postoperative complications. There were no factors found to be associated with early postoperative morbidity. The most common long-term complication was biliary stricture, which occurred in 10 patients (14%). Patients whose BDIs were repaired in the intermediate period were more likely to develop biliary stricture than patients with repairs performed in the immediate or late periods (P = .03). CONCLUSIONS Our results suggest that the timing of LC-BDI repair is an important determinant of long-term outcome. Repairs in the intermediate period were significantly associated with biliary stricture. Thus, repairs should be undertaken either in the immediate (0-72 hours) or delayed (>6 weeks) periods after LC.