Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy

Abstract

BackgroundIatrogenic injury to the bile ducts is the most feared complication of cholecystectomy and several are the possibilities to occur.AimTo compare the cases of iatrogenic lesions of the biliary tract occurring in conventional and laparoscopic cholecystectomy, assessing the likely causal factors, complications and postoperative follow-up.MethodsRetrospective cohort study with analysis of records of patients undergoing conventional and laparoscopic cholecystectomy. All the patients were analyzed in two years. The only criterion for inclusion was to be operative bile duct injury, regardless of location or time of diagnosis. There were no exclusion criteria. Epidemiological data of patients, time of diagnosis of the lesion and its location were analyzed.ResultsTotal of 515 patients with gallstones was operated, 320 (62.1 %) by laparotomy cholecystectomy and 195 by laparoscopic approach. The age of patients with bile duct injury ranged from 29-70 years. Among those who underwent laparotomy cholecystectomy, four cases were diagnosed (1.25 %) with lesions, corresponding to 0.77 % of the total patients. No patient had iatrogenic interventions with laparoscopic surgery.ConclusionLaparoscopic cholecystectomy compared to laparotomy, had a lower rate of bile duct injury.

Total Cost of Hospitalization of Patients Undergoing Elective Laparoscopic Cholecystectomy Related to Nutritional Status

“…Individuals who have had complications during surgery, in turn, had higher costs of hospitalization compared with those without complications. In this group of patients a prolonged hospitalization was necessary, which may not occur in cases of post-surgery complication 4 , 8 .…”

During which period should we avoid cholecystectomy in patients who underwent endoscopic retrograde cholangiopancreatography?

“…The LC requiring conversion to open surgery were performed 4 to 30 days after ERCP, with a conversion rate of 9.1%, which supports the data presented. (18,19,28,30) Although a very individual choice of each surgeon, abdominal cavity drainage in cholecystectomies, in our service, is only used in surgical procedures leading to technical difficulties and when the surgical team is unsure about potential iatrogenic injury or bleeding in the liver bed. According to Fortunato et al, LC performed immediately after or up to 3 days after ERCP reduces the risk of injury during the surgical procedure and the need for abdominal cavity drainage.…”

Laparoscopic Right Posterior Sectoral Bile Duct Injury Recognized Postoperatively: How to Manage it?

“…Elevated laboratory tests of cholestasis and leucocytosis may be seen. 10,11 Ultrasonography or CT is the first choice of imaging method to detect intraabdominal collection. In our case, when the patient was readmitted to the hospital with abdominal pain, she was evaluated first by sonogragraphy and a subhepatic collection with mild elevation of cholestasis enzymes were detected, then MRCP imaging was performed.…”