The impact of vascular injuries on the management of bile duct injury following laparoscopic cholecystectomy- insights from a prospective study

Rohith Kodali; Utpal Anand; Kunal Parasar; Rajeev N Priyadarshi; Ramesh Kumar; Basant N Singh; Kislay Kant

doi:10.1016/j.hpb.2024.12.022

The impact of vascular injuries on the management of bile duct injury following laparoscopic cholecystectomy- insights from a prospective study

HPB (Oxford). 2025 Jan 6:S1365-182X(24)02470-5. doi: 10.1016/j.hpb.2024.12.022. Online ahead of print.

Authors

Rohith Kodali¹, Utpal Anand², Kunal Parasar¹, Rajeev N Priyadarshi³, Ramesh Kumar⁴, Basant N Singh¹, Kislay Kant¹

Affiliations

¹ Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India.
² Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India. Electronic address: [email protected].
³ Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India.
⁴ Department of Medical Gastroenterology, All India Institute of Medical Sciences, Patna, India.

PMID: 39824715
DOI: 10.1016/j.hpb.2024.12.022

Abstract

Background: Our study aimed to compare the clinical presentation and outcomes of post-cholecystectomy bile duct injuries (BDI) with and without arterial injuries.

Methods: A prospective analysis of 123 patients with post-cholecystectomy BDI between July 2018 and January 2022 was performed. Multivariate logistic regression analysis was used to assess the impact of vascular injuries on perioperative complications and long-term outcomes after delayed repair.

Results: Of 123 patients, 42 (34%) had associated vascular injuries, predominantly right hepatic artery disruptions. These patients experienced significantly higher perioperative complications after the index surgery (Cholangiolar abscess- 83.3% vs 32.1% ( p<0.001), recurrent cholangitis- 66.67 % vs 14.81 % ( p<0.001), blood transfusions ³2 - 89.74 % vs 28.57 % ( p<0.001), hospital admissions ³3 - 3.88 ± 1.99 vs 2.49 ± 0.74 ( p<0.001). Delayed Hepp-Couinaud biliary repair was performed in 112 patients. After a median follow-up, of 2 years, 85 (51.43 % vs. 88.16 % ), 12 (25.71 % vs. 3.89 %), 6 (11.43 % vs. 2.59 %), and 9 (11.43 % vs. 6.49 %) patients had excellent, good, fair, and poor outcomes.

Conclusion: Concomitant vasculobiliary injuries were associated with increased morbidity after index surgery; however, the long-term outcomes following definitive biliary repair remained comparable.