Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

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)

¹Others: Gallbladder polyp and etc. CBD: Common bile duct; IHD: Intrahepatic duct; BDI: Bile duct injury; IQR: Interquartile range; GB: Gallbladder.

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)

BDI: Bile duct injury.

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)

EST: Endoscopic sphincterotomy; BDI: Bile duct injury.

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

BDI: Bile duct injury.

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

IHD: Intrahepatic duct; CBD: Common bile duct; CHD: Common hepatic duct; ERC: Endoscopic retrograde cholangiography; PTC: Percutaneous transhepatic cholangiography; PCD: Percutaneous drainage; M: Male; F: Female.

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)

EST: Endoscopic sphincterotomy; BDI: Bile duct injury.