El-Dhuwaib, Y, Slavin, J, Corless, J, Begaj, I, Durkin, D and Deakin, M (2016) Bile duct reconstruction following laparoscopic cholecystectomy in England. Surgical Endoscopy: surgical and interventional techniques, 30 (8). 3516- 3525. ISSN 1432-2218

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Abstract

Objectives
To determine the incidence of bile duct reconstruction (BDR) following laparoscopic cholecystectomy (LC) and to identify associated risk factors.

Background
Major bile duct injury (BDI) requiring reconstruction is a serious complication of cholecystectomy.

Methods
All LC and attempted LC operations in England between April 2001 and March 2013 were identified. Patients with malignancy, a stone in bile duct or those who underwent bile duct exploration were excluded. This cohort of patients was followed for 1 year to identify those who underwent BDR as a surrogate marker for major BDI. Logistic regression was used to identify factors associated with the need for reconstruction.

Results
In total, 572,223 LC and attempted LC were performed in England between April 2001 and March 2013. Five hundred (0.09 %) of these patients underwent BDR. The risk of BDR is lower in patient that do not have acute cholecystitis [odds ratio (OR) 0.48 (95 % CI 0.30–0.76)]. The regular use of on-table cholangiography (OTC) [OR 0.69 (0.54–0.88)] and high consultant caseload >80 LC/year [OR 0.56 (0.39–0.54)] reduced the risk of BDR. Patients who underwent BDR were 10 times more likely to die within a year than those who did not require further surgery (6 vs. 0.6 %).

Conclusions
The rate of BDR following laparoscopic cholecystectomy in England is low (0.09 %). The study suggests that OTC should be used more widely and provides further evidence in support of the provision of LC services by specialised teams with an adequate caseload (>80).

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Springer at https://doi.org/10.1007/s00464-015-4641-8 Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: bile duct injury; bile duct reconstruction; hospital episode statistics data; laparoscopic cholecystectomy; on-table cholangiography
Subjects: R Medicine > R Medicine (General)
R Medicine > RD Surgery
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 03 Feb 2016 10:49
Last Modified: 07 Jun 2018 08:52
URI: http://eprints.keele.ac.uk/id/eprint/1435

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