Outcomes of surgery for post-cholecystectomy bile duct injuries: An audit from a tertiary referral center

Ray, Sukanta; Sanyal, Sumit; Das, Somak; Jana, Koustav; Das, Anupam; Khamrui, Sujan

doi:10.1016/j.jviscsurg.2019.08.005

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…In conclusion, the present study confirms that the incidence ceiling of LBDI during laparoscopic cholecystectomy (LC) did not fall below the threshold of 0.5%, which is double than the incidence rate reported by the most significant studies analyzing the incidence of open vs. laparoscopic incidence rates during LC ( 14 ). It is obvious that there is still much effort to be put into significantly lowering this threshold ( 15 , 16 ). One way towards reaching this goal should be that all surgeons strictly adhere to the basic concept of always obtaining the critical view of safety advocated by Strasberg ( 17 ) and outlined by many studies published over the years ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…For major BDIs (i.e., Strasberg E) associated with tissue loss and whenever an ischemic injury is suspected, a Roux-en-Y hepaticojejunostomy is the recommended method of reconstruction [9,111,122,[125][126][127][128], with the placement of a T-tube at a healthy region of the common bile duct, either proximal or distal to the injury, to decrease the incidence of future stricture formation [129]. Any dissection in the hilum may make subsequent reconstruction more difficult or cause further biliary or vascular injury.…”

Section: Management Of Intraoperatively Diagnosed Bdimentioning

confidence: 99%

“…However, it must be considered that in some countries or regions, a tertiary/specialist care center may be too distant, and the "traveling surgeon" practice may be inappropriate [20,127]. In these specific cases, it is of utmost importance to assure an optimal local management before referral, especially when, due to logistic and geographical constraints, the time prior to transport may be prolonged [20].…”

Section: Management Of Intraoperatively Diagnosed Bdimentioning

confidence: 99%

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

et al. 2021

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Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

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“…We had a policy of performing delayed repair (>6 weeks), with control of intra-abdominal sepsis and nutritional stabilization of the patients, or an ontable repair if diagnosed intraoperatively. Bilioenteric drainage (Roux-en-Y hepaticojejunostomy in 7 patients) is the preferred treatment option for major duct injury; however, end-to-end common bile duct repair over the T-tube (1 patient) is also the safe option for sharp transaction injuries without segment loss and a nonelectrocautery injury [2,3]. ere was no restricture in those eight patients who required on-table and delayed repair at a median follow-up of 13 months.…”

Section: Minimally Invasive Surgerymentioning

confidence: 99%

“…Both the procedures are associated with the risk of bile duct injury, with the risk being 0.4-0.6% and 0.2-0.3% for laparoscopic and open cholecystectomy, respectively [2]. e bile duct injury significantly increases the healthcare cost, morbidity, and mortality and decreases survival [3,4]. However, the data of risk stratification of bile duct injury are a decade old.…”

Section: Introductionmentioning

confidence: 99%

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

Pandit

Yadav

Awale

et al. 2020

Minimally Invasive Surgery

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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.

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Outcomes of surgery for post-cholecystectomy bile duct injuries: An audit from a tertiary referral center

Cited by 11 publications

References 26 publications

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

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

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

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

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