Improved outcomes of bile duct injuries in the 21st century

Henry A. Pitt, Stuart Sherman, Matthew S. Johnson, Andrew N. Hollenbeck, Jonathan Lee, Michael R. Daum, Keith D. Lillemoe, Glen Lehman

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: The objectives of this analysis were to compare the outcomes of bile duct injuries by specialist over time and the role of management timing and biliary stents. Background: Postoperative bile duct injuries require multidisciplinary management. In recent years, advancements have occurred in patient evaluation and in timing and type of therapy. Methods: A multidisciplinary team managed 528 patients over 18 years. Mean age was 52 years; 69% were women and 95% had a cholecystectomy and/or bile duct exploration. Patients were classified by the Strasberg system as having bile leaks (type A, n = 239, 45%) or bile duct injuries (types B-E, n = 289, 55%). Injury outcomes from 1993 to 2003 (n = 132) were compared with those from 2004 to 2010 (n = 157). A successful outcome was defined as no need for further intervention after 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, 40%) followed by surgeons (N = 104, 36%) and interventional radiologists (N = 70, 24%). Overall success rates were best for surgery (88%, P<0.05) followed by endoscopy (76%) and interventional radiology (50%) and improved over time (78% vs 69%). Outcomes were best for surgery in recent years (95% vs 80%, P < 0.05) and for patients stented for more than 6 months (P < 0.01). 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 are best with surgical management and in patients who are stented for more than 6 months.

Original languageEnglish (US)
Pages (from-to)490-497
Number of pages8
JournalAnnals of surgery
Volume258
Issue number3
DOIs
StatePublished - Sep 1 2013

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Bile Ducts
Wounds and Injuries
Bile
Time Management
Interventional Radiology
Cholecystectomy
Endoscopy
Stents
Therapeutics

Keywords

  • Bile duct injury
  • Bile duct stricture
  • Bile leak and cholecystectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Improved outcomes of bile duct injuries in the 21st century. / Pitt, Henry A.; Sherman, Stuart; Johnson, Matthew S.; Hollenbeck, Andrew N.; Lee, Jonathan; Daum, Michael R.; Lillemoe, Keith D.; Lehman, Glen.

In: Annals of surgery, Vol. 258, No. 3, 01.09.2013, p. 490-497.

Research output: Contribution to journalArticle

Pitt, HA, Sherman, S, Johnson, MS, Hollenbeck, AN, Lee, J, Daum, MR, Lillemoe, KD & Lehman, G 2013, 'Improved outcomes of bile duct injuries in the 21st century', Annals of surgery, vol. 258, no. 3, pp. 490-497. https://doi.org/10.1097/SLA.0b013e3182a1b25b
Pitt HA, Sherman S, Johnson MS, Hollenbeck AN, Lee J, Daum MR et al. Improved outcomes of bile duct injuries in the 21st century. Annals of surgery. 2013 Sep 1;258(3):490-497. https://doi.org/10.1097/SLA.0b013e3182a1b25b
Pitt, Henry A. ; Sherman, Stuart ; Johnson, Matthew S. ; Hollenbeck, Andrew N. ; Lee, Jonathan ; Daum, Michael R. ; Lillemoe, Keith D. ; Lehman, Glen. / Improved outcomes of bile duct injuries in the 21st century. In: Annals of surgery. 2013 ; Vol. 258, No. 3. pp. 490-497.
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abstract = "Objective: The objectives of this analysis were to compare the outcomes of bile duct injuries by specialist over time and the role of management timing and biliary stents. Background: Postoperative bile duct injuries require multidisciplinary management. In recent years, advancements have occurred in patient evaluation and in timing and type of therapy. Methods: A multidisciplinary team managed 528 patients over 18 years. Mean age was 52 years; 69{\%} were women and 95{\%} had a cholecystectomy and/or bile duct exploration. Patients were classified by the Strasberg system as having bile leaks (type A, n = 239, 45{\%}) or bile duct injuries (types B-E, n = 289, 55{\%}). Injury outcomes from 1993 to 2003 (n = 132) were compared with those from 2004 to 2010 (n = 157). A successful outcome was defined as no need for further intervention after 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, 40{\%}) followed by surgeons (N = 104, 36{\%}) and interventional radiologists (N = 70, 24{\%}). Overall success rates were best for surgery (88{\%}, P<0.05) followed by endoscopy (76{\%}) and interventional radiology (50{\%}) and improved over time (78{\%} vs 69{\%}). Outcomes were best for surgery in recent years (95{\%} vs 80{\%}, P < 0.05) and for patients stented for more than 6 months (P < 0.01). 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 are best with surgical management and in patients who are stented for more than 6 months.",
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