Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study

Abstract

ObjectivesLaparoscopic cholecystectomy - associated bile duct injury is a clinical problem with bad outcome. The study aimed to analyze the outcome of surgical management of these injuries.Patients and methodsWe retrospectively analyzed 69 patients underwent surgical management of laparoscopic cholecystectomy related major bile duct injuries in the period from the beginning of 2013 to the beginning of 2018.ResultsRegarding injury type; the Leaking, Obstructing, leaking + obstructing, leaking + vascular, and obstructing + vascular injuries were 43.5%, 27.5%, 18.8%, 2.9%, and 7.2% respectively. However, the Strasberg classification of injury was as follow E1 = 25, E2 = 32, E3 = 8, and E4 = 4. The definitive procedures were as follow: end to end biliary anastomosis with stenting, hepaticojejunostomy (HJ) with or without stenting, and RT hepatectomy plus biliary reconstruction with stenting in 4.3%, 87%, and 8.7% of patients respectively. According to the time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and 1.5months), and late (after1.5 months) management were 13%, 14.5%, and 72.5% respectively. The hospital and/or 1month (early) morbidity after definitive treatment was 21.7%, while, the late biliary morbidity was 17.4% and the overall mortality was 2.9%, on the other hand, the late biliary morbidity-free survival was 79.7%. On univariate analysis, the following factors were significant predictors of early morbidity; Sepsis at referral, higher Strasberg grade, associated vascular injury, right hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis, and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sepsis at referral, end to end anastomosis with stenting, reconstruction without stenting, liver cirrhosis, operative bleeding, and early morbidity.ConclusionSepsis at referral, liver cirrhosis, and operative bleeding were significantly associated with both early and late morbidities after definitive management of laparoscopic cholecystectomy related major bile duct injuries, so it is crucial to avoid these catastrophes when doing those major procedures.

Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study

“…Our cohort study included 410 patients with the following inclusion criteria: infants with a sure diagnosis of BA, Type III BA, completed KPE and operation done at our Institute, however, the exclusion criteria were cases that did not complete the follow-up, cases with data loss and cases of research refusal. It is a single institutional retrospective analysis of a prospectively collected database that analyzed the short- and long-term outcomes after this operation in the period from the beginning of 2000 to mid-2020 after approval of our institutional review board (IRB); where patients were observed from POD1 until the end of June 2020 or until the death of patients with a median follow up period of 44 (range, 0.2–243) months [ 29 , 30 ]. The study was registered in the Chinese clinical trial registry with registration NO of ChiCTR2000038541(Web site: Chinese Clinical Trial Registry (ChiCTR))…”

“…Univariate analysis and then multivariate analysis (by Binary logistic regression method or Cox regression method) were done to detect the relationship between the different pre-, intra-, and post-operative variables and jaundice clearance at the 6th-month post-operatively as well as the relation between these variables and long-term(20-year) NLS. The Kaplan–Meier method was used for survival analysis to assess the long-term NLS and its predictors as well as the overall survival, a P-value of <0.05 was significant [ 29 , 30 ].…”

Challenging situations in cholecystectomy and strategies to overcome them

“…However, the conclusion of the registry is that cholecystectomy should not be delayed in patients with an adequate indication. One of the largest series of laparoscopic cholecystectomies in cirrhotic patients was recently published by Gad et al [23]. In a cohort of 213 cirrhotic patients operated between 2011 and 2019, 30-day morbidity and mortality were 22.1 and 2.3%.…”

Bile duct injuries after cholecystectomy, analysis of constant risk

“…20 Controversies about the treatment of these patients continue, however, the control of sepsis, biliary peritonitis, and timely referral to patients, a multidisciplinary approach in a center with experience in this type of case, can improve the results and improve morbidity and survival and is an essential and recommended step when making decisions in this type of patients. 21,22 Bile duct injuries remain severe complications of biliary tract surgery. Different factors affect their outcomes.…”