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Time of Surgical Repair Impacts 30-days Postoperative Complications but not Long Term Outcomes after Bile Duct Injury: Lessons from 600 cases
Ismael Dominguez-Rosado*1, Miguel Angel Mercado2, William G Hawkins1
1Washington University in St. Louis, St.Louis, MO;2Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Mexico, Mexico

OBJECTIVE:
The impact of timing of repair on postoperative morbidity and long term outcomes after bile duct injury is unclear. We sought to determine the appropriate time for repair in order to minimize postoperative complications and long term anastomotic failures.
METHOD:
A single institution prospective database was queried for all Strasberg E1 to E4 injuries during 1989-2014 using a standardized tabular reporting format. Repairs were stratified into three groups [immediate (<7 days), early (7 days until 6 weeks), and late (>6 weeks) after injury]. Basic NSQIP/procedure specific 30-days postoperative complications, and anastomotic failures were considered endpoint variables. Multivariate logistic stepwise regression was used for comparisons.
RESULTS:
Mean age of the 614 included patients was 41; 77% female; and mean follow up of 40.5 months. Side to side hepatojejunostomy was performed in 90% of cases. Early repair was associated with a higher risk of 30-days postoperative complications after adjusting for ASA, previous repair attempts and preoperative sepsis [HR=1.6, 95% CI (1.1-2.4), p=0.02].
NSQIP-procedure specific 30-days postoperative complications and postoperative biliary stents are independent predictors of anastomotic failure after controlling for previous repair attempt, as shown in Table 1.
CONCLUSIONS:
Time of repair between 7 days and 6 weeks is associated with 30-days NSQIP/procedure specific postoperative complications but not long term anastomotic failures. Repair of injuries presenting in this time period should be delayed if feasible.


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