Clinical presentation, management and outcomes of bile duct injuries after laparoscopic cholecystectomy: a 15-year single-center experience in Vietnam

Abstract

ObjectivesTo evaluate the clinical presentation, management, and outcomes of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC).MethodsThis is a case series of 28 patients with BDIs after LC treated at a tertiary hospital in Vietnam during the 2006-2021 period. The BDI's clinical presentations, Strasberg classification types, management methods, and outcomes were reported.ResultsBDIs were diagnosed intraoperatively in 3 (10.7%) patients and postoperatively in 25 (89.3%). The BDI types included Strasberg A (13, 46.4%), D (1, 3.6%), E1 (1, 3.6%), E2 (4, 14.3%), E3 (5, 17.9%), D + E2 (2, 7.1%), and nonclassified (2, 7.1%). Of the postoperative BDIs, the injury manifested as biliary obstruction (18, 72.0%), bile leak (5, 20.0%), and mixed scenarios (2, 8.0%). Regarding diagnostic methods, endoscopic retrograde cholangiopancreatography (ERCP) was more useful in bile leak scenarios, while multislice computed tomography, magnetic resonance cholangiopancreatography, and percutaneous transhepatic cholangiography were more useful in biliary obstruction scenarios. All 28 BDIs were successfully treated. ERCP with stenting was very effective in the majority of Strasberg A BDIs. For more complex BDI types, hepaticocutaneous jejunostomy was a safe and effective approach. The in-hospital morbidities included postoperative pneumonia (2, 10.7%) and biliary-enteric anastomosis leakage (1, 5.4%). There was no cholangitis or anastomotic stenosis during the follow-up after discharge (median 18 months).ConclusionsThe majority of BDIs are type A and diagnosed postoperatively. ERCP is effective for the majority of Strasberg A BDIs. For major and complex BDIs, hepaticocutaneous jejunostomy is a safe and effective approach.

Magnetic Resonance Cholangiography Diagnosing Post-cholecystectomy Biliary Injuries

“…Clinical manifestations and laboratories are non-specific, and the diagnosis requires high suspicion. In this investigation, it was observed that 15% of patients received an intraoperative diagnosis akin to the findings reported by Vu et al albeit lower than the estimates reported in the literature, where it is suggested that approximately one-third of patients with Strasberg A-D lesions, and up to 70-80% of patients with Strasberg E lesions, have an intraoperative diagnosis [ 6 , 8 , 17 ].…”

“…Although Strasberg type A lesion is the most common post-cholecystectomy form [ 6 , 27 ], in our research, the most frequent types were E2 and E4, with a percentage of 25% each. This distribution aligns with the findings of studies by Wani et al in 2019, who classified bile duct lesions with MR cholangiography in 25 patients, with types E3 (40%), E2 (36%), and E4 (12%) being the most frequent [ 28 ].…”

“…The study's limitations predominantly stem from its observational, retrospective, descriptive design and small sample size. Nevertheless, the low incidence of this type of lesion is worth considering, similarly reflected in the small literature series reporting 10 and 28 included patients [ 5 , 6 , 14 , 25 , 26 , 30 ]. Additionally, it is pertinent to mention the possibility of selection bias when considering a population with a high pretest probability for bile duct injury.…”

“…Cholecystectomy ranks among one of the most common surgical procedures, with approximately 60,000 cases carried out annually in Colombia alone, and it is the most common laparoscopic procedure [ 1 ]. Despite its frequency, bile duct lesions represent a significant and concerning complication following both open and laparoscopic cholecystectomy, with an estimated incidence ranging from 0.1% to 0.92%, being more frequent in the latter group [ 2 - 6 ]. These lesions entail considerable morbidity, with rates escalating up to 8.8%, and require complex management strategies [ 2 - 4 ].…”