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January 2011January 17, 2011

Timing of Repair of Bile Duct Injuries Associated With Laparoscopic Cholecystectomy—Reply

Author Affiliations

Author Affiliation: Hepatobiliary and Pancreatic Surgical Group, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Arch Surg. 2011;146(1):117-118. doi:10.1001/archsurg.2010.291

In reply

We thank Dr Nuzzo and colleagues for the comments regarding our recent article.1 They raise the issue of definition of repairs at 0 hours (ie, intraoperative repair at the time of attempted laparoscopic cholecystectomy). This strategy was not common in our series or others in North America.2 Most of our patients underwent laparoscopic cholecystectomy at outside hospitals and were referred to our institution for definitive treatment of a recognized LC-BDI. In principle, intraoperative recognition and repair of an LC-BDI may be optimal, with results similar to other immediate repairs (≤72 hours). However, we believe that LC-BDI repairs should be performed by specialized high-volume hepatopancreatobiliary (HPB) surgeons. For most general surgeons, HPB specialists may not be available for immediate reconstruction. We promote an approach that includes early recognition of LC-BDIs by general surgeons and early referral to HPB specialty care. Our institution offers 24-hour access to HPB surgeons. This allows early, often intraoperative telephone consultation to take place between the general surgeon and an HPB surgeon. This approach facilitates communication between general surgeons and HPB services, early transfer, and immediate repair of intraoperatively identified LC-BDIs.

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