Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons

Philip R de Reuver, Erik A Rauws, Marco J Bruno, Johan S Lameris, Olivier R Busch, Thomas M van Gulik, Dirk J Gouma
Surgery 2007, 142 (1): 1-9

BACKGROUND: Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) has an enormous socioeconomic impact on patients. BDI has been associated with severe morbidity, impaired survival, and poor long-term quality of life. This study was performed to analyze the impact of a multidisciplinary approach in BDI patients on survival.

METHODS: A prospective cohort study was performed in a tertiary referral center to determine the effect of a multidisciplinary treatment on survival in 500 bile duct injury patients. Referral pattern and patient survival after bile duct injury are analyzed, and a survey was performed on the prevalence of medical litigation in bile duct injury patients.

RESULTS: The number of patients referred to the Amsterdam Medical Center increased to 0.3% of the total number of patients, yearly undergoing laparoscopic cholecystectomy in the Netherlands. The referral rate to the departments of gastroenterology (n = 329), surgery (n = 146), and radiology (n = 25) was, respectively, 66%, 29%, and 5%. After referral to the tertiary center, 150 patients (30%) were internally referred to a different department to optimize treatment. The 10-year survival rate in bile duct injury patients is not significantly worse compared with the age-matched general Dutch population (89% vs 88%, P = .7). Overall, 19% of the patients submitted a medical litigation claim against the initial surgeon or hospital. In total, 40% of these claims were resolved in the favor of the patients through settlement or verdict.

CONCLUSIONS: BDI is a severe complication in modern surgical practice. BDI is associated with major morbidity and high rates of litigation claims. The detrimental effect of BDI on survival can be prevented if gastroenterologists, radiologists, and surgeons work together in a multidisciplinary team.

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