Management of iatrogenic bile duct injuries: Multiple logistic regression analysis of predictive factors affecting morbidity and mortality
Ela Ekmekcigil1, Ömer Ünalp1, Alper Uğuz1, Ruslan Hasanov1, Halil Bozkaya2, Timur Köse3, Mustafa Parıldar2, Ömer Özütemiz4, Ahmet Çoker1
Objective: Iatrogenic bile duct injuries remain a challenge for the surgeons to overcome. The predictive factors affecting morbidity and mortality are important for determining the best management modality.
Materials and Methods: The patients who referred to Ege University Faculty of Medicine after laparoscopy associated iatrogenic bile duct injury are grouped according to Strasberg–Bismuth classification system. The type and number of prior attempts, concomitant complications, and treatment modalities are analyzed using the SPSS version 18 (IBM, Chicago, IL, USA). The variables with p<0.10 were considered for univariate analysis and then evaluated for predictive factors by forward Logistic Regression method using multiple logistic regression analysis.
Results: According to the analysis of 105 patients who were referred during 2004–2014, the type and number of prior attempts are considered predictive factors in sepsis. In multiple logistic regression analysis, abscess formation, concomitant vascular injury, and serum bilirubin level are significantly effective in predicting mortality.
Conclusion: The management of iatrogenic bile duct injuries should be carefully planned with a multidisciplinary approach. The predictive factors affecting morbidity and mortality are important in determining the best modality for managing iatrogenic bile duct injuries. Abscess formation, vascular injury, and serum bilirubin level are the potential risk factors. Therefore, we can strongly recommend immediate assessment of patients for prompt diagnosis and referring to an HPB center, to avoid further injuries.
Keywords: Bile duct injury, laparoscopy, predictive factors
This study was presented at the 11th E-AHPBA congree in Manchester 21-24 August 2015, United Kingdom.
Cite this paper as: Ekmekcigil E, Ünalp Ö, Uğuz A, Hasanov R, Bozkaya H, Köse T, et al. Management of iatrogenic bile duct injuries: Multiple logistic regression analysis of predictive factors affecting morbidity and mortality Turk J Surg 2018; 34(4): 264-270.
Written informed consent was obtained from the patient for publication of this manuscript.
Concept A.Ç.; Design - A.Ç., E.E.; Supervision - A.Ç., Ö.Ö.; Resource - Ö.Ü., A.U.; Materials - E.E., R.H.; Data Collection and/or Processing - E.E., H.B.; Analysis and/or Interpretation - E.E., T.K., A.Ç.; Literature Search - Ö.Ü., M.P.; Writing Manuscript - E.E.; Critical Reviews - A.Ç., M.P., Ö.Ö.; Other - M.S.
The authors have no conflicts of interest to declare.
The author declared that this study has received no financial support.
Special thanks to Prof. Dr. Murat Sözbilen for his great effort in performing surgeries.