Early vs late management of biliary tract injury

Abstract

Introduction: The rate of biliary tract injury following laparoscopic cholecystectomy is estimated at 0.4–1.5% and is associated with high morbidity. Diagnosis is based on imaging, and surgical treatment may be performed early or delayed; there is controversy regarding the best time to perform surgical management. Aim: To describe and compare early vs. late surgical management of biliary tract injury after laparoscopic cholecystectomy. Methodology: A retrospective study between 2017-2022 in a tertiary center was conducted, clinical records of patients ≥18 years with biliary tract injury post laparoscopic cholecystectomy were reviewed, two groups were organized, early surgical management (≤6 weeks), and late management (>6 months) were compared, and post-surgical outcomes between groups were reported, a p value = <0.05 was considered statistically significant. Results y discussion: 84 patients were analyzed, 32 patients underwent early surgical management and 52 subjects received delayed management, the mean age was 50 years (SD ±15); the most frequent injury was type 2 (75%), the mean hospital stay was longer in the early management group 33 days vs. the late management group (33 vs. 12 days; p = <0.001), postsurgical complications (81% vs. 1.9%; p = 0.001), reinterventions (84.3% vs. 0%; p = 0.001) and mortality (12.5% ​​vs. 0%; p = 0.019). Conclusion: Early surgical management is associated with higher morbidity and mortality compared to late surgical management.