• Ismael Dominguez-Rosado, Dominic E Sanford, Jingxia Liu, William G Hawkins, and Miguel A Mercado.
• *Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico †Department of Surgery, Washington University School of Medicine, Siteman Cancer Center and Barnes Jewish Hospital. Saint Louis, MO ‡Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO.
• Ann. Surg. 2016 Sep 1; 264 (3): 544-53.

ObjectiveOur goal was to determine the optimal timing for repair of bile duct injuries sustained during cholecystectomy.BackgroundBile duct injury during cholecystectomy is a serious complication that often requires surgical repair. There is heterogeneity in the literature regarding the optimal timing of surgical repair, and it remains unclear to what extent timing determines postoperative morbidity and long-term anastomotic function.MethodsA single institution prospective database was queried for all E1 to E4 injuries from 1989 to 2014 using a standardized tabular reporting format. Timing was stratified into 3 groups [early (<7 days), intermediate (8 days until 6 weeks), and late (>6 weeks) after injury]. Analysis was stratified between those who had a previous bile duct repair or not, including postoperative complications and anastomotic failure as outcome variables in 2 separate multivariate logistic regression models.ResultsThere were 614 patients included in the study. The mean age was 41 years (range, 15-85 yrs), and the majority were female (80%). The mean follow-up time was 40.5 months. Side-to-side hepaticojejunostomy was performed in 94% of repairs. Intermediate repair was associated with a higher risk of postoperative complications [odd ratio = 3.7, 95% confidence interval (1.3-10.2), P = 0.01] when compared with early and late in those with a previous repair attempt. Sepsis control and avoidance of biliary stents were protective factors against anastomotic failure.ConclusionsAdequate sepsis control and delayed repair of biliary injuries should be considered for patients presenting between 8 days and 6 weeks after injury to prevent complications, if a previous bile duct repair was attempted.

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