Current Scenario of Postcholecystectomy Bile Leak and Bile Duct Injury at a Tertiary Care Referral Centre of Nepal

Abstract

Objective. With the adoption of safe cholecystectomy principles at an academic institute, the risk of major bile duct injury has decreased. This study aims at evaluating the present status of bile duct injury, compared to the study published in 2013 by index centre. Methods. This is a retrospective review of a prospectively maintained database of bile leak and bile duct injury from 2014 to 2019. Patients who completed postcholecystectomy bile leak or bile duct injury treatment and were on regular follow-up were included. Results. Eighteen patients (0.78%) among 2,300 consecutive cholecystectomies presented with bile duct injury, including 8 (0.35%) major bile duct injuries and 10 (0.43%) bile leaks compared to major bile duct injury rate of 0.68% (92/11,345 cholecystectomies) between 2001 and 2010. Injuries were classified as Strasberg’s type A (52.9%), type D (5.9%), and type E (41.1%). Eight patients (47%) of bile leak were managed conservatively with drains, while two required laparotomy and lavage. The mean time for spontaneous closure of bile leak was 11 days. Intraoperative repair was done in three cases: Roux en Y hepaticojejunostomy in 2 and end-to-end repair over T-tube in 1 for sharp transection of the duct. Delayed repair (Roux-en-Y hepaticojejunostomy) was done in five patients. The median postcholecystectomy hospital stay was 8 days, with no mortality. There was no restricture at a median follow-up of 13 months. Conclusion. With the adoption of a safe culture of cholecystectomy, the major bile duct injury rate has decreased currently. Repair of bile duct injury by experienced hepatobiliary surgeon results in excellent outcome.

Experiencia del manejo por colangiopancreatografía retrógrada endoscópica de las fístulas biliares poscolecistectomía en un hospital de referencia en Colombia

“…Las principales manifestaciones clínicas fueron el aumento de la producción biliar a través del dren abdominal y aumento del dolor abdominal, que a su vez se asociaron a manejo temprano (mediana de 3 días). Por el contrario, la sepsis abdominal con colecciones y peritonitis biliar fueron menos frecuentes (29% y 12%) y tardías, estos hallazgos son similares a otros estudios como el de Pandit y colaboradores, que encontraron sepsis de origen abdominal en el 35% de los pacientes (26) , lo cual podría sugerir que un diagnóstico y manejo oportunos reducen las complicaciones. En nuestra serie de casos, el hallazgo de fístula biliar durante la cirugía fue del 33%, que es mayor a la de por colangioresonancia antes de la intervención endoscópica.…”

“…Técnica endoscópica, n (%) -Papilotomía -Inserción de prótesis plástica -Combinada El tiempo de resolución en el 80% fue menor de 3 días; al diferenciar por tipo de terapia endoscópica, la papilotomía sola otras publicaciones con reportes entre el 8% y el 22% (26,27) , lo cual en nuestro estudio permitió un manejo endoscópico más temprano. El uso de imágenes como ecografía y tomografía fueron útiles para el diagnóstico de colecciones abdominales, mientras que la colangiorresonancia se realizó solo en 3 pacientes y fue diagnóstica en 1 caso, lo cual contrasta con otros estudios en los que su uso fue mayor (28) .…”

Sphincterotomy Alone Versus Sphincterotomy and Biliary Stent Placement in the Treatment of Bile Leaks: 10 Year Experience at a Quaternary Hospital

“…Less commonly, abdominal trauma with hepatic damage can also be the etiology of bile leaks. Cholecystectomy is one of the most common types of abdominal surgery and bile leaks post cholecystectomy can result in increased morbidity, mortality, hospital expenditures and a decreased quality of a patient´s life (14) . Other frequent causes of bile leaks include biliopancreatic surgery, liver transplants, hepatectomies and hepatic trauma (12) .…”

Presentation Of Post Cholecystectomy Bile Duct Injuries In A Tertiary Care Hospital

“…One of the most frequent digestive health issues is gallstones.Laparoscopic cholecystectomy (LC) is the preferred method for removing the gallbladder in the treatment of symptomatic cholelithiasis due to its decreased postoperative mortality and morbidity rates 1 .Cholecystectomy is one of the most common gastrointestinal surgical procedures to be performed laparoscopically 2 .Compared to open cholecystectomy, bile duct injuries (BDI) are more prevalent and severe, with areported frequency of 0.6 % for laparoscopic and 0.1 % for open cholecystectomy.These injuries are a tragedy for surgeons and patients because of the accompanying morbidity,extended hospitalization, and death 3,4 .…”