Patient outcomes and healthcare costs following iatrogenic bile duct injuries: A national multicentre retrospective cohort study.

BACKGROUNDS/AIMS: Iatrogenic bile duct injuries (IBDIs) are an uncommon but potentially severe complication of laparoscopic cholecystectomy. The aim of this study was to assess both peri-operative and long-term outcomes of the current surgical management of IBDIs in Ireland and to estimate the associated costs.

METHODS

Patients who underwent management for IBDIs following laparoscopic cholecystectomy between 2014 and 2024 were retrospectively identified from the three hepatobiliary (HPB) centres in Ireland. Data collected included demographics, surgical details, and perioperative as well as long-term outcomes. Cost analysis was conducted using the activity-based funding in-patient price list from the healthcare pricing office.

RESULTS

A total of 34 patients underwent surgical intervention for IBDIs. Of these, 26 patients (76.4%) underwent Roux-en-Y hepaticojejunostomy, while primary bile duct repair was performed in five patients (14.7%). Three patients (8.8%) required right hepatectomy in conjunction with hepaticojejunostomy. Ten (29.4%) patients required re-operation, including four of the five who initially underwent primary repair. One patient ultimately required orthotopic liver transplant, and there were three (12.5%) peri-operative deaths. No statistically significant differences in peri-operative outcomes were observed between intra-operative and post-operative diagnosis of BDI. The median direct in-patient treatment cost was estimated at  €85,961.

CONCLUSIONS

IBDIs pose a considerable risk of long term complications and mortality with substantial costs to the health service. Subspecialist HPB referral is key to successful management, which typically involves bilio-enteric anastomosis and occasional liver resection if associated with major vascular injury.