Management of major bile duct injuries following laparoscopic and open cholecystectomy - single center experience

Abstract

Introduction/Objective. Bile duct injuries represent a devastating and potentially life-threatening consequence of cholecystectomy. Although most cholecystectomies are currently performed laparoscopically, some complex cases require an open approach. The aim of this report is to present and analyze a single center experience regarding the management of these injuries. Methods. A retrospective study was conducted in a tertiary referral institution. During a 13-year period, we identified a total of 64 patients. Only patients requiring surgical reconstruction to repair bile duct injuries were included in the study. Patients were grouped according to the type of surgical approach, i.e. laparoscopic or open cholecystectomy. Results. Out of 64 patients with bile duct injuries, 38 (59.4%) incurred the injuries during open and 26 (40.6%) during laparoscopic cholecystectomy. No differences between the groups were observed concerning the time of bile duct injury diagnosis, type of injury, incidence of concomitant vascular and bile duct injuries, type of reconstruction procedure or complication rates after the primary intervention. The latency of bile duct injury management was found to differ between the study groups. In the open cholecystectomy group, bile duct injuries were managed significantly later than in the laparoscopic one. Conclusion. The results suggest that bile duct injuries occur with equal frequency after laparoscopic as well as open cholecystectomy. However, injuries are managed later after open than after laparoscopic cholecystectomy. Tertiary centers have satisfactory outcomes of major bile duct injury reconstruction, with low rates of both morbidity and mortality.

Use of negative pressure in wound therapy

“…The use of negative pressure in wound healing is an innovative therapeutic method that accelerates the wound healing process. This technique can be applied in different types of surgery [4,5,6,7] to treat different types of acute and chronic wounds. Wound therapy with controlled negative pressure is a technique based on the principle of suction, which evacuates excess exudate from the wound using subatmospheric pressure.…”

“…Upotreba negativnog pritiska u zarastanju rana je inovativna terapijska metoda koja ubrzava proces zarastanja rana. Ova tehnika se može primenjivati u različitim vrstama hirurgije [4,5,6,7] za tretiranje različitih vrsta akutnih i hroničnih rana. Terapija rane kontrolisanim negativnim pritiskom predstavlja tehniku koja je zasnovana na principu sukcije, kojom se evakuiše višak eksudata iz rane upotrebom subatmosferskog pritiska.…”

Scientific misconduct

“…Usvajanjem jednoobraznog uputstva za pripremu rada, povećao se broj mladih istraživača koji tokom stasavanja u poznate naučnike, pripremaju doktorske/magistarske teze [30], i objavljuju rukopise u prestižnim domaćim [31,32] ili svetskim časopisima [33][34][35][36]. Obaveza svakog istraživača, je da deluje u skladu sa etičkim normama naučno-istraživačkog kodeksa, i da učestvuje u otkrivanju i suzbijanju svakog oblika devijantnog ponašanja.…”