SEATTLE, WASHINGTON. Cholecystectomy (surgical removal of the gallbladder) is a very common procedure. It is estimated that about 750,000 Americans undergo the procedure every year in order to deal with the problem of gallstones. Unfortunately, about 1 in 200 (0.5%) of patients having cholecystectomy end up with serious injury to the common bile duct (CBD) as a result of the surgery. This injury must then be repaired through additional surgery.
Researchers at the University of Washington have just released the results of a study aimed at determining
the impact of CBD injury on survival after cholecystectomy. The study involved almost 1.6 million patients
(62.9% women with an average age of 71 years), 7911 (0.5%) of whom had experienced CBD. The
average (median) years of survival after cholecystectomy was 5.6 years. However, after 9.2 years of follow-
up 80% of the patients who had experienced CBD injury had died as compared to 45% of patients who had
no CBD injury. The death rate among CBD patients was particularly high at 26% during the first year after
cholecystectomy as compared to 7% among those without CBD injury. After adjusting for other relevant
variables the researchers conclude that cholecystectomy patients who experienced CBD injury were 3 times
more likely to die during the 9-year follow-up period than were those who did not get injured. This increased
risk was not age-related, but persisted in a group of 178,000 patients with an average age of 55 years. The
researchers also observed that survival among CBD patients improved significantly if the bile duct repair
was performed by a more experienced surgeon than the one who had caused the initial injury.
Unfortunately, 75% of bile duct repairs were done by the original surgeon.
Editor's comment: It is very clear from this report that experience is the key factor in achieving a successful CBD repair. The researchers noted that the risk of death during the 9-year follow-up period decreased by 11% for every one case that the repairing surgeon had dealt with in his career. So if you have to undergo cholestectomy or, even more important, a CBD repair, don't settle for an inexperienced surgeon!