Abstract
Background
Outcomes after Strasberg grade E bile duct injury have been widely reported. However,
there are comparatively few reports of outcomes after Strasberg A to D bile duct injury.
Therefore, the aim of this study was to comprehensively evaluate the long-term clinical
and economic impact of Strasberg A to D bile duct injury.
Methods
Patients with Strasberg A to D bile duct injury were identified from a prospectively
collected and maintained database. Long-term biliary complication rates, as well as
treatment costs were then estimated, and compared across Strasberg injury grades.
Results
A total of N = 120 patients were identified, of whom N = 49, 13, 20, and 38 had Strasberg grade A, B, C, and D bile duct injury, respectively.
Surgical repair was most commonly performed in Strasberg grade D injuries (74% vs
8%–20% in lower grades, P < .001). By 5 years post bile duct injury, the estimated long-term biliary complication
rate was 40% in Strasberg grade D injuries, compared with 15% in Strasberg grade A
(P = .022). A significant difference in total treatment and follow-up costs was also
detected (P < .001), being highest in Strasberg grade D injuries (mean £11,048/US$14,252 per
patient) followed by the Strasberg grade B group (mean £10,612/US$13,689 per patient).
Discussion
Strasberg grade A to D injuries lead to considerable long-term morbidity and cost.
Strasberg grade D injuries are typically managed surgically and result in the highest
complication rate and treatment costs. Strasberg grade B injuries lead to a similar
complication rate and treatment cost but are often managed without surgery.
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Article info
Publication history
Published online: March 14, 2020
Accepted:
January 31,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
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