The group researched complications associated with combined vascular and bile duct injuries that occur during cholecystectomy.
The findings of the study were published in the June issue of the Archives of Surgery.
A total of 27 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).
The incidence and level of biliary and arterial injuries, and their resulting morbidity and mortality, were measured.
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 (27%), endoscopic retrograde pancreatography (39%), and percutaneous transhepatic cholangiography (14%).
The team found that delayed referral was more common in levels I through IV (100 days) than in level V (15 days).
| A quarter of bile duct injuries had arterial complications.
| Archives of Surgery |
Repairs were attempted in level IV (75%), III (67%), V (25%), and II (11%).
Some 13 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%), with resulting higher rates of complication (70% vs 23%).
Five deaths occurred in the CI group, compared with 1 in the NC group.
It was also discovered that, in univariate analysis, the presence of arterial injury versus no arterial injury was a predictor of mortality (38% of 13 patients vs 3% of 36 patients).
Dr Joseph F. Buell, of the University of Cincinnati, Cincinnati, Ohio, USA, concluded on behalf of his colleagues, "Bile duct injuries after cholecystectomy can be morbid and lethal, with the incidence of arterial injury grossly underestimated."