IMPROVEMENT IN THE MANAGEMENT OF BILE-DUCT INJURIES

Background: Previous studies have suggested that improvements in diagn ostic workup and treatment of bile duct injuries (BDI) sustained durin g laparoscopic cholecystectomy can be expected as experience increases with the laparoscopic procedure. Many published articles reported tha t early diagnosis, proper classification, and optimal timing of treatm ent of BDI increase the likelihood of successful treatment. This study determined whether diagnosis and management of BDI have improved over the years. Study Design: Between June 1990 and November 1996, 106 pat ients were diagnosed and treated in the Amsterdam Academic Medical Cen ter for BDI sustained during laparoscopic cholecystectomy. Detailed in formation was obtained about peroperative findings, time interval from laparoscopic cholecystectomy to symptoms, and interval from symptoms to diagnosis. Bile duct injuries were classified into four types. Two patient groups were compared: BDI patients diagnosed from 1990 until 1 994 (''learning phase'') and patients diagnosed from 1995 until 1996. Results: Bile duct injuries combined with bile leakage were diagnosed significantly earlier in the second period after the learning phase. T he percentages of injuries diagnosed peroperatively, ''blind laparotom ies,'' and suboptimal timed hepaticojejunostomies were not different b etween the groups. Conclusions: Except for earlier diagnosis of BDI in the later period than in previous years, there appeared to be no sign ificant improvement in diagnostic workup and management during the pas t 2 years. (J Am Coll Surg 1998;187:246-254. (C) 1998 by the American College of Surgeons)