Clinical and surgical algorithm for managing iatrogenic bile duct injuries during laparoscopic cholecystectomy: A multicenter study

Abstract

The present study was a multicenter, analytical, nonrandomized research on 108 cases of intraoperative vascular and bile duct lesions during laparoscopic cholecystectomies. We selected these cases from 16,559 cholecystectomies performed entirely laparoscopically or debuted laparoscopically and converted to an open approach. The study included two surgical centers labeled as primary, with extensive experience in hepato-biliary reconstructive surgery, and four other centers labeled as secondary that referred cases to the previous two. Our study analyzed several key parameters such as the percentage of iatrogenic lesions recorded, the variability of the main biliary pathway and conformation as well as its relationship to the adjacent critical anatomical landmarks, the anatomical and physiopathological characteristics of pathology requiring surgical intervention, factors related to laparoscopic surgical technique, the surgical technique used to repair the recorded lesions, the duration of survivability and the rate of the occurring complications. Based on the analysis of these parameters, we developed a descriptive algorithm with visual representation relying on several decisional points to guide the surgeons in choosing the optimal treatment method so that patients will benefit from a favorable clinical path.

Photographic analysis of the anatomical landmarks in bile duct injury

“…The patient was referred to the hepatobiliary centre for immediate repair according to the proposed algorithm for management of BDI. 1 A photographic analysis of this classical BDI revealed that misidentification was the cause of the injury, which was consistent with the Delphi consensus. 2 Surgeons tend to interpret their visual information in terms of what they 'want' to see, and our desires can alter what we see by influencing the way we process visual information.…”

“…The surgeon observed bile leakage after dividing the two cystic structures distally and proximally. The patient was referred to the hepatobiliary centre for immediate repair according to the proposed algorithm for management of BDI 1 . A photographic analysis of this classical BDI revealed that misidentification was the cause of the injury, which was consistent with the Delphi consensus 2 .…”

Posterior Calot’s triangle approach would be a better choice for chronic atrophic cholecystitis: a retrospective controlled study

“…The reported rate of occurrence of BDI in LC is approximately 0.5-0.85% 7 . Once bile duct injury occurs, it will bring a heavy blow to both patients and surgeons, and even seriously affect the patient's quality of life 8,9 .…”

“…The reported rate of occurrence of BDI in LC is approximately 0.5-0.85% 7 . Once bile duct injury occurs, it will bring a heavy blow to both patients and surgeons, and even seriously affect the patient's quality of life 8,9 .Anatomic variations of Calot's triangle were found to be closely associated with BDI during LC 10 . There are some important ducts in Calot's triangle, such as cystic artery, hepatic artery, accessory hepatic duct, and anatomical variations often occur here.…”

Risk factors for bile duct injury after laparoscopic cholecystectomy

“…Laparoscopic cholecystectomy (LC) is a common method for treating gallbladder diseases, with the advantages of small trauma, simple surgical operation, short surgical time, fast recovery after surgery, etc [1,2] . Bile duct injury (BDI) is a kind of serious and difficult surgical complications, and these complex injuries are often caused by LC, the incidence rate can reach 0.3% to 1.4% [3,4] .…”