Does Timing of Laparoscopic Bile Duct Injury Repair affect Long-term Outcome?

Objective: This article will review the controversies and prevailing views that deal with the vexing questions of “what is the optimal time of repair” that delivers the best long-term outcome following laparoscopic surgery injury of bile duct system. Materials and methods: Literature review conducted using Google search engine and HighWire press, using keywords, like bile duct injuries, timing of repair, outcome and laparoscopic cholecystectomy. Results: The reported incidence of bile duct injury after laparoscopic cholecystectomy varies widely due to the inclusion or exclusion of minor or self-limited events, such as bile leak from intrahepatic radicles or leak from a cystic stump. Once a major bile duct injury occurs, early recognition is paramount to minimize morbidity and potential mortality. Once recognized, appropriate measures are instituted to address the damage. However, controversy surrounds as to the optimal time for repair of the injury. The literature gives conflicting assessment and interpretation of when such injuries should be repaired. Patients cared for in facilities that lack the expertise to perform immediate repair may inherently end up at a tertiary referral center in a delayed manner. Some recognized institutions and individual surgeons with the expertise and resources to perform immediate repair opt for repair without delay claiming good outcomes while others delay the repair to intermediate and late repairs with claims of equally good outcomes reported. Conclusion: While immediate recognition of any injury is mandatory for improved patient outcome, the timing of repair remains controversial with convincing arguments on both sides of the issue. However, there seems to be more evidence to support either immediate repair in experienced hands or delayed repair beyond six weeks. Intermediate repair (within 3 to 14 days) is more likely to lead to failures and long-term complications.