Halle-Smith, James MHodson, JamesStevens, Lewis GDasari, BobbyMarudanayagam, RaviPerera, ThamaraSutcliffe, Robert PMuiesan, PaoloIsaac, JohnMirza, Darius FRoberts, Keith J2025-04-092025-04-092020-03-14Halle-Smith JM, Hodson J, Stevens LG, Dasari B, Marudanayagam R, Perera T, Sutcliffe RP, Muiesan P, Isaac J, Mirza DF, Roberts KJ. A comprehensive evaluation of the long-term clinical and economic impact of minor bile duct injury. Surgery. 2020 Jun;167(6):942-949. doi: 10.1016/j.surg.2020.01.022. Epub 2020 Mar 140039-60601532-736110.1016/j.surg.2020.01.02232183995http://hdl.handle.net/20.500.14200/7391Background: 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.enCopyright © 2020 Elsevier Inc. All rights reserved.GastroenterologySurgeryArticle