Recent classifications of the common bile duct injury

Background and Aims: Bile leak is a rarely encountered complication most commonly occurring in the setting of biliary tract surgery. Site of leak may be from the gallbladder bed, the cystic duct, or rarely from injury to a major bile duct. Management has evolved with from radical surgery prevalent in earlier days to recent increased expertise in biliary endoscopy. This study aims to determine the impact of endoscopic management in treating symptomatic bile leak and discusses the role of surgery. Patients and Methods: In this retrospective study, patients with symptomatic bile leak admitted between 2012 and 2015 to the Department of Gastroenterology of a tertiary care center in Western India were analyzed. Site and extent of bile leak was evaluated using contrast enhanced computed tomography or magnetic resonance cholangiopancreatography. Endoscopic retrograde cholangiopancreatography (ERCP) was mainly used as a therapeutic tool rather than a diagnostic tool. ERCP was used as a primary mode of treatment wherever feasible. Percutaneous biliary drainage was used in technically difficult cases. Results: Twenty-seven patients with symptomatic bile leak were identified in aforesaid period. Bile leak in 21 (77.88%) patients was due to postlaparoscopic cholecystectomy injury, while in 6 (22.22%) patients, it was associated with liver abscess. Major bile duct injury was seen in 10 patients with postcholecystectomy status and in 5 patients with liver abscess. Out of 27 cases, 25 (92.59%) were treated with ERCP and 2 (7.40%) with percutaneous drainage. Surgery was not required in any of the patients. Sphincterotomy with stent placement for 6 weeks was effective in 23 (92%) patients, and only sphincterotomy was effective in 2 (8%) patients undergoing ERCP. There was no mortality due to bile leak. Conclusion: Most patients presenting with bile leak including major bile duct injury without complete bile duct transection can be successfully treated by endoscopic therapy without the need for surgery.

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“…Figure 1b]. [12] None of our patients had complete transection of bile duct which necessitates percutaneous drainage and surgical approach.…”

Section: Resultsmentioning

confidence: 91%

Successful Endoscopic Management of Bile Leak: A Single-Center Experience

Pawar

Sonthalia

Pawar

et al. 2017

Journal of Digestive Endoscopy

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“…Many BDI classification schemes have been published (e.g. Bismuth, Strasber, EAES [15,16]), yet not one of them has been widely adopted and used as a standard for reporting of BDI, which causes room for bias in comparing different studies and reports. Regardless of the differences in incidence data, the high frequency of this surgical procedure makes BDI a significant burden on healthcare systems, with BDI being a costly complication to treat.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the usefulness of the SAGES Safe Cholecystectomy Program from the viewpoint of the European surgeon.

Bogacki¹,

Krzak²,

Gotfryd-Bugajska³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: Common bile duct injury (CBDI) is a severe complication of laparoscopic cholecystectomy (LC). To minimize its occurrence, SAGES established the Safe Cholecystectomy Program (SCP) with 6 rules to follow during surgery. Aim: To assess the knowledge of SCP among European surgeons and their opinion on its usefulness. Material and methods: Data were gathered using questionnaires during surgical conferences in Poland and Denmark. The questionnaire asked about the surgeon's experience in cholecystectomy and the number of complications in the form of CBDI. It asked about the surgeon's opinion on the usefulness of SCP rules on a 10-point scale. A comparison between specialists and residents was performed. The study has been registered in the ClinicalTrials. gov-NCT03155321. Results: One hundred eighty-four questionnaires were gathered. One hundred fourteen (61.96%) specialists (72.8% male, mean age: 50 years) and 70 (38.04%) residents (56% male, mean age: 34 years) completed the questionnaire. Mean work experience was 22 years among specialists and 4.5 years among residents. A high percentage of specialists have experienced CBDI (46% vs. 17% of residents, p = 0.014). More specialists are familiar with the SCP than residents (49.3% vs. 21.7%, p = 0.021). Significant differences in the mean usefulness score were observed for three rules: rules 2 and 6 were found more useful by residents (mean score: 7.07 vs. 6.01, p = 0.025 and 8.70 vs. 8.27, p < 0.001), and rule 3 was found more useful by specialists (mean: 8.73 vs. 8.36, p < 0.001). Conclusions: The awareness of the SCP in Europe is low. Participants consider the rules of the SCP to be useful during surgery, although there are differences in the usefulness scores between the groups. An educational program to promote and further implement the SCP should be established.

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“…1 BDIs are more frequent during laparoscopic cholecystectomy compared with an open procedure (0.3% open vs. 0.6% laparoscopic) 2 and are mostly recognized postoperatively as bile leak and biliary obstruction. 3,4 Despite the improvement in the surgical techniques for the laparoscopic cholecystectomy and the institution of preventive methods, the overall incidence of bile duct injuries have remained unchanged. With increasing costs of medical care, complications like bile duct injuries not only significantly add to the cost of management along with mental and physical stress on the patient, but are also one of the reasons for many medicolegal litigations.…”

Section: Introductionmentioning

confidence: 99%

Bile Duct Injury—Classification and Prevention

Nasa

Sharma

Gupta

et al. 2020

Journal of Digestive Endoscopy

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Iatrogenic bile duct injuries (BDI) are commonly encountered after laparoscopic cholecystectomy. Timely recognition of these injuries is important as the outcome depends on the optimal management and there is significant impact on the patient’s quality of life. Therapeutic management is guided by the type and extent of the bile duct injury and availability of expertise, and includes involvement of endoscopic, surgical, and radiological approaches.

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Recent classifications of the common bile duct injury

Cited by 82 publications

References 19 publications

Successful Endoscopic Management of Bile Leak: A Single-Center Experience

Successful Endoscopic Management of Bile Leak: A Single-Center Experience

Evaluation of the usefulness of the SAGES Safe Cholecystectomy Program from the viewpoint of the European surgeon.

Bile Duct Injury—Classification and Prevention

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