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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Jun 14, 2014; 20(22): 6924-6931
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6924
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6924
Table 1 Strasberg classification of biliary injury
Class | Description |
A | Injury to small ducts in continuity with biliary system, with cystic duct leak |
B | Injury to sectoral duct with consequent obstruction |
C | Injury to sectoral duct with consequent bile leak from a duct not in continuity with biliary system |
D | Injury lateral to extrahepatic ducts |
E1 | Stricture located > 2 cm from bile duct confluence |
E2 | Stricture located < 2 cm from bile duct confluence |
E3 | Stricture located at bile duct confluence |
E4 | Stricture involving right and left bile ducts |
E5 | Complete occlusion of all bile ducts |
Table 2 Study patients n (%)
Variables | Total (n = 77) |
Age (yr, range) | 49.94 (20-81) |
Sex | |
Male | 46 (60) |
Disease | |
GB stones with/without CBD stones | 52 (68) |
IHD stones | 11 (14) |
Others1 | 14 (18) |
Operation | |
Laparoscopic surgery | 49 (64) |
Open laparotomy | 28 (36) |
Bile duct exploration | 43 (56) |
Time to diagnosis [median, d (IQR)] | 13 (5-90) |
Follow up period [median, d (IQR)] | 339 (200-817) |
Table 3 Characteristics of study patients according to types of bile duct injurys n (%)
Variables | Total (n = 77) |
BDI type | |
Type 1 (leak only) | 36 (47) |
Type 2 (stricture only) | 31 (40) |
Type 3 (combined) | 10 (13) |
BDI type (Strassberg classification) | |
Type A | 36 (47) |
Type B | 10 (13) |
Type C | 31 (40) |
Type D | 0 (0) |
Length of stricture, mm (median) | 3.2 (2.3-3.7) |
Size of bile leak, mm (median) | 6 (2-12) |
Table 4 Treatment success rate according to clinical characteristics n (%)
Success rate | P value | |
Overall | 59/77 (77) | |
Age (yr) | 0.467 | |
≤ 50 | 32/40 (80) | |
> 50 | 27/37 (73) | |
Sex | 0.101 | |
Female | 27/31 (69) | |
Male | 32/46 (77) | |
Bile duct exploration | 0.291 | |
Yes | 31/43 (72) | |
No | 28/34 (82) | |
Operation method | 0.387 | |
Laparoscopic | 36/49 (74) | |
Open | 23/28 (82) | |
Operation name | 0.247 | |
Cholecystectomy | 40/55 (72) | |
Other operations | 19/22 (86) | |
Initial procedure | 0.547 | |
Endoscopic | 28/38 (74) | |
Percutaneous | 31/39 (80) | |
EST | 0.310 | |
Yes | 28/39 (72) | |
No | 31/38 (82) | |
BDI | 0.000 | |
Type 1 | 34/36 (94) | |
Type 2 | 22/31 (71) | |
Type 3 | 3/10 (30) | |
Time to diagnosis (d) | 0.325 | |
≤ 15 | 34/42 (81) | |
> 15 | 25/35 (71) | |
Treatment duration (d) | 0.950 | |
≤ 30 | 30/39 (77) | |
> 30 | 29/38 (76) |
Table 5 Clinical Characteristics according to bile duct injury type
BDI type | 1 | 2 | 3 | P value |
Patients (n) | 36 | 31 | 10 | |
Age (mean, yr) | 50 | 52 | 44 | 0.321 |
Male | 56% | 65% | 60% | 0.756 |
Bile duct exploration | 44% | 65% | 70% | 0.161 |
Laparoscopic surgery | 72% | 48% | 80% | 0.067 |
Cholecystectomy | 64% | 74% | 90% | 0.246 |
Endoscopic sphincterotomy | 31% | 54% | 78% | 0.059 |
Complication rate | 11% | 36% | 20% | 0.056 |
Time to diagnosis (median, d) | 6 | 216 | 11 | 0.000 |
Table 6 Clinical characteristics and treatment outcomes of patients with bile duct injury type 3
Sex/age | Result | Operation | Time to diagnosis (d) | Number of procedures | Treatment duration (d) | Leak location | Stricture location | ||
ERC | PTC | PCD | |||||||
F/37 | Success | Cholecystectomy | 10 | 2 | 7 | 2 | 180 | Multiple | Anastomosis |
M/40 | Failure | Cholecystectomy | 5 | 1 | 1 | 0 | 5 | IHD | IHD/ |
F/26 | Success | Cholecystectomy | 59 | 2 | 0 | 1 | 94 | CBD/CHD | CBD/CHD |
M/22 | Failure | Cholecystectomy | 21 | 0 | 3 | 0 | 69 | CBD/CHD | CBD/CHD |
F/50 | Failure | Cholecystectomy | 5 | 1 | 2 | 0 | 13 | Duct stump | IHD |
M/45 | Failure | Cholecystectomy | 0 | 1 | 0 | 0 | 45 | CBD/CHD | CBD/CHD |
M/25 | Failure | Cholecystectomy | 13 | 1 | 1 | 0 | 7 | CBD/CHD | CBD/CHD |
M/45 | Failure | Rt. hepatectomy | 12 | 0 | 1 | 1 | 45 | IHD | IHD |
F/65 | Success | Cholecystectomy | 60 | 5 | 0 | 0 | 364 | CBD/CHD | CBD/CHD |
M/81 | Failure | Cholecystectomy | 8 | 1 | 5 | 4 | 482 | Duct stump | IHD |
Table 7 Subgroup analyses of 55 patients who underwent cholecystectomy n (%)
Success rate | P value | |
Overall | 40/55 (73) | |
Age (yr) | 0.428 | |
≤ 50 | 14/21 (67) | |
> 50 | 26/34 (775) | |
Sex | 0.359 | |
Female | 17/21 (81) | |
Male | 23/34 (68) | |
Bile duct exploration | 0.185 | |
Yes | 16/25 (64) | |
No | 24/30 (80) | |
Operation method | 1.000 | |
Laparoscopic | 29/40 (73) | |
Open | 11/15 (73) | |
EST | 0.537 | |
Yes | 25/36 (69) | |
No | 15/19 (79) | |
BDI | 0.001 | |
Type 1 | 22/23 (96) | |
Type 2 | 15/23 (65) | |
Type 3 | 3/9 (33) | |
Time to diagnosis (d) | 0.322 | |
≤ 15 | 22/28 (79) | |
> 15 | 18/27 (68) | |
Treatment duration (d) | 1.000 | |
≤ 30 | 17/24 (71) | |
> 30 | 23/31 (74) |
- Citation: Eum YO, Park JK, Chun J, Lee SH, Ryu JK, Kim YT, Yoon YB, Yoon CJ, Han HS, Hwang JH. Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes. World J Gastroenterol 2014; 20(22): 6924-6931
- URL: https://www.wjgnet.com/1007-9327/full/v20/i22/6924.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i22.6924