Early Repair of Common Bile Duct Injuries Achieves Superior Outcomes and May Reduce Malpractice Litigation

Abstract

The optimal timing of repair after common bile duct injury (CBDI) during cholecystectomy remains controversial. We evaluated outcomes after early versus late repair and examined associated malpractice litigation. Methods: We retrospectively reviewed patients who underwent surgical repair of CBDI between January 2012 and December 2023. Collected data included demographics, operative indication, timing of injury recognition and repair, preoperative assessment, operative classification (primary repair, single anastomosis, multiple anastomoses), and postoperative outcomes. Early repair was defined as intraoperative or ≤3 days after injury and late repair as >3 days. Malpractice claims were identified via the Westlaw database and institutional release-of-information requests. Results: Fifty-four patients met inclusion criteria: 12 primary repairs, 37 single anastomoses, and 5 multiple anastomoses. 23 patients underwent early repair and 31 underwent late repair. Groups were comparable in demographics and baseline laboratory values. Median time from diagnosis to repair was 0 days in the early repair group versus 10 days in the late repair group (P < 0.001). All strictures (n = 5) occurred in the late repair group (P = 0.023); one required partial hepatectomy and the remainder were managed with dilation. Bile leaks were managed with percutaneous drainage in 1 early-repair and 4 late-repair cases. One death occurred in the late-repair group. Three patients filed malpractice suits; one plaintiff verdict occurred. Conclusion: Early repair of CBDI yielded excellent clinical outcomes in our series. The incidence of malpractice litigation after CBDI is uncommon. Early definitive intervention by experienced hepatobiliary surgeons should be considered when feasible.