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Improved Outcomes of Bile Duct Injuries in the 21st Century
Henry A Pitt, Stuart Sherman*, Matthew S Johnson*, Andrew N Hollenbeck*, Jonathan Lee*, Alex K Malone*, Keith D Lillemoe, Glen A Lehman*
Indiana University School of Medicine, Indianapolis, IN

OBJECTIVE(S): Postoperative bile duct injuries require multidisciplinary management. In recent years advancements have occurred in patient evaluation as well as in timing and type of therapy. Therefore, the aims of this analysis were to compare the outcomes of bile duct injuries by specialist and over time.
METHODS: A multidisciplinary team managed 543 patients over 18 years. Mean age was 51 years; 71% were female; and 97% had a cholecystectomy and/or bile duct exploration. Patients were classified by the Strasberg system as having bile leaks (Type A, n=239, 44%) or bile duct injuries (Types B-E, n=304, 56%). Injury outcomes from 1993-03 (n=140) were compared to those from 2004-10 (n=160). A successful outcome was defined as no need for further intervention following the initial 12-months of therapy. Standard statistical methods were employed.
RESULTS: Patients with bile leaks were managed almost exclusively by endoscopists (96%) with a 96% success rate. Patients with bile duct injuries were managed most often by endoscopists (N=115, 38%) followed by surgeons (N=104, 34%) and interventional radiologists (N=85, 28%). Success rates for bile duct injuries are presented in the table.
CONCLUSIONS: Almost all bile leaks and many bile duct injuries can be managed successfully by endoscopists. Selected proximal injuries can be treated by interventional radiologists with modest success. Outcomes of bile duct injuries have improved over time and, currently, are best with surgical management.
PeriodInt. Radiol.EndoscopySurgeryOverall
1993-0341%72%*80%*67%
2004-1058%†82%*95%*†‡79%†
1993-1052%77%*88%*‡74%
*p<0.05 vs Int. Radiol, †p<0.05 vs 1993-03, ‡p<0.05 vs Endoscopy


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