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Perils of cholecystectomy

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.
Flum, DR, et al. Bile duct injury during cholecystectomy and survival in Medicare beneficiaries. Journal of the American Medical Association, Vol. 290, October 22/29, 2003, pp. 2168-73

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!

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