Trends in Clinical and Medical Sciences
Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 341 – 347
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-imrv052
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-imrv052
Biliary tract injury during open and laparoscopic cholecystectomy and management: An observational study at the tertiary care teaching hospital
Dr. Udayanath Behera\(^{1}\), Dr. Sridhar Panda\(^{2}\), Dr. Smrutirekha Behera\(^{3}\) and Dr. Deepak Ranjan Nayak\(^{4,*}\)
\(^{1}\) Assistant Professor, Department of Anaesthesia, SCB Medical College and Hospital, Cuttack, Odisha.
\(^{2}\) Assistant Professor, Department of Medicine, SCB Medical College and Hospital, Cuttack, Odisha.
\(^{3}\) Assistant Professor, Department of Pathology, FM Medical College and Hospital, Balasore, Odisha.
\(^{4}\) Assistant Professor, Department of Surgery, SCB Medical College and Hospital, Cuttack, Odisha.
Correspondence should be addressed to Dr. Deepak Ranjan Nayak at dr.deepak67@gmail.com
Copyright © 2023 Dr. Udayanath Behera, Dr. Sridhar Panda, Dr. Smrutirekha Behera and Dr. Deepak Ranjan Nayak. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: October 23, 2022 – Accepted: May 5, 2023 – Published: May 20, 2023
Abstract
Background: Bile duct injuries after laparoscopic cholecystectomy (LC), being one of the most commonly performed surgical procedures, remain a substantial problem in gastrointestinal surgery. The most important aspect regarding this issue is the prevention of bile duct injury during index cholecystectomy. Once it occurs, early and accurate diagnosis of bile duct injury is very important for surgeons and gastroenterologists, because unidentified bile duct injury may result in severe complications such as hepatic failure and death. Laboratory tests, radiological imaging, and endoscopy play an important role in the diagnosis of biliary injuries.
Material and Methods: This is a prospective, single-center, observational study including patients treated for a bile duct injury during a cholecystectomy at the tertiary care Teaching Hospital over a period of 1 year. All patients were older than 18 years and were informed of the study and gave informed consent. All types of iatrogenic injuries were included: minor or more complex, regardless of their management (endoscopic, radiological, surgical, or combined). Other biliary injury etiologies, mainly traumatic causes, were excluded. Minor wounds were defined as those affecting the cystic stump, the cystic duct, and the junction between the cystic duct and the MBD, and major wounds were defined as those affecting the MBD, the common hepatic duct, and the right hepatic branch.
Results: Out of 90 patients with bile duct injuries, 58 (64.4%) incurred the injuries during open cholecystectomy and 32 (35.6%) 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: Bile duct injury after laparoscopic cholecystectomy requires a multidisciplinary approach with specialized physicians at tertiary hospitals. Imaging techniques and proper classification are required in order to prevent or treat sepsis, biliary leaks, and collections.
Material and Methods: This is a prospective, single-center, observational study including patients treated for a bile duct injury during a cholecystectomy at the tertiary care Teaching Hospital over a period of 1 year. All patients were older than 18 years and were informed of the study and gave informed consent. All types of iatrogenic injuries were included: minor or more complex, regardless of their management (endoscopic, radiological, surgical, or combined). Other biliary injury etiologies, mainly traumatic causes, were excluded. Minor wounds were defined as those affecting the cystic stump, the cystic duct, and the junction between the cystic duct and the MBD, and major wounds were defined as those affecting the MBD, the common hepatic duct, and the right hepatic branch.
Results: Out of 90 patients with bile duct injuries, 58 (64.4%) incurred the injuries during open cholecystectomy and 32 (35.6%) 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: Bile duct injury after laparoscopic cholecystectomy requires a multidisciplinary approach with specialized physicians at tertiary hospitals. Imaging techniques and proper classification are required in order to prevent or treat sepsis, biliary leaks, and collections.
Keywords:
Biliary tract; Laparoscopic cholecystectomy; Hepatobiliary surgeons.