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Lookup NU author(s): Professor Sanjay PandanaboyanaORCiD
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© 2017 IJS Publishing Group LtdBackground There is still a debate regarding the optimal management of bile duct injury following cholecystectomy. Our aim was to ascertain if delayed referral influenced clinical outcomes for patients with BDI treated in our institution. Materials and methods We interrogated a prospectively maintained database, including all patients with BDI (Bismuth and Strasberg classifications) post LC managed in our unit from 2000-2014. Referrals were arbitrarily defined as early (<96 h from the injury) and delayed (>96 h). Results 68 patients with BDI were managed. Patient demographics, referral time, level of injury and morbidity data was collected. 50 patients (77%) required a surgical bile duct reconstruction. The Early referral Group included 33 patients (52.4%) and Delayed referral group 30 (47.6%). The patients referred late had a significantly high incidence of right hepatic artery injury (23% vs. 3%) and the overall number of complications (0.0001). The average number of surgical interventions (2.5 vs 1.8, p < 0.05) and invasive procedures (4 vs. 2.5, p < 0.05) per patient was high in the late referral group. There was significant difference in the interval between BDI-to-reconstruction (median 3 vs. median 88 days, p < 0.05) and referral-to-hospital discharge (median 9 vs. median days 59, p < 0.05). On multivariate analysis only delayed referral (OR 7.58, 95% CI 2.1–26.6) and Strasberg-E injuries (OR 4.86, 95% CI 1.1–20.9) were significant. Conclusion A late referral was associated with a higher incidence of post-treatment complications, greater need for invasive procedures and a longer recovery period. These observations support the need for early patient transfer to a tertiary institution following BDI.
Author(s): Martinez-Lopez S, Upasani V, Pandanaboyana S, Attia M, Toogood G, Lodge P, Hidalgo E
Publication type: Article
Publication status: Published
Journal: International Journal of Surgery
Year: 2017
Volume: 44
Pages: 82-86
Online publication date: 16/06/2017
Acceptance date: 11/06/2017
ISSN (print): 1743-9191
ISSN (electronic): 1743-9159
Publisher: Elsevier Ltd
URL: https://doi.org/10.1016/j.ijsu.2017.06.042
DOI: 10.1016/j.ijsu.2017.06.042
PubMed id: 28629763
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