Complex bile duct injuries after laparoscopic cholecystectomy: a comparative outcomes analysis of patients treated in tertiary private and public health facilities in Cape Town, South Africa

Abstract

Background: The South African healthcare system has an under-financed public sector serving most of the population and a better resourced private  sector serving a small fraction of the population. This study evaluated management and outcome in patients with complex bile duct injuries (BDIs) after  laparoscopic cholecystectomy referred from either private or public hospitals.

Methods: The data of patients who underwent hepaticojejunostomy repair were retrieved from a prospectively maintained central departmental BDI  database. Patients were treated either in the Surgical Gastroenterology Unit at Groote Schuur Hospital, University of Cape Town (UCT) or the Digestive  Diseases Centre, UCT Private Academic Hospital by the same hepatobiliary surgical team. Relevant preoperative clinical data and postoperative  complications and outcomes were compared between patients originating either in the public or private sector.

Results: One hundred and twenty-five patients were included, 58 from the public and 67 from the private sector. The type of BDI, time to diagnosis,  referral and repair were similar. Patients referred from the private sector underwent more percutaneous cholangiograms prior to referral (11.9% vs 1.7%,  p = 0.037). Patients referred from the public sector underwent more CT examinations (p = 0.044) and endoscopic retrograde cholangiography (p = 0.038)  after admission to our centre. There were no statistically significant differences in 30-day postoperative complications. Primary patency rates were similar  for public and private referrals (90% vs 88%, respectively). There were two BDI-related mortalities at 90 days.

Conclusions: Despite differences in public and private healthcare system resources, patients were referred early and appropriately from both sectors and  had similar postoperative outcomes when treated in a specialised unit.