Long-term effects of iatrogenic bile duct injury during cholecystectomy

Abstract

Background & aims: The aim of this study was to study survival, factors influencing survival, and causes of death after iatrogenic reconstructed bile duct injury in a large population-based Swedish cohort.

Methods: Patients who underwent cholecystectomy in the period from 1965 to 2005 were identified from the Swedish Inpatient Register. The bile duct injury cohort consisted of patients with procedure codes indicating reconstructive biliary surgery within 1 year of the cholecystectomy, excluding patients with reconstruction owing to other causes than bile duct injury.

Results: Of 374,042 cholecystectomy patients, 1386 were classified as afflicted by bile duct injury requiring reconstructive surgery. Survival was significantly lower in the injured cohort compared with the noninjured cohort, with a hazard ratio of 3.73 (95% confidence interval, 3.30-4.22) at 1 year that gradually evened out thereafter. The risk of dying from liver diseases was increased 4-fold in the bile duct injury cohort compared with the general population. Older age and comorbidity increased the risk of dying, whereas the use of intraoperative cholangiogram improved survival.

Conclusions: Patients with iatrogenic reconstructed bile duct injury have a decreased survival rate compared with noninjured cholecystectomy patients. Patients' younger age, absence of other diseases, and routine use of intraoperative cholangiogram seem to be positive prognostic survival factors. These patients also may be at increased risk of dying from liver diseases, although this issue requires further study.