Comparing early and delayed repair of common bile duct injury to identify clinical drivers of outcome and morbidity

Kirks, Russell C.; Barnes, T.E.; Lorimer, Patrick D.; Cochran, Allyson; Siddiqui, Imran; Martinie, John B.; Baker, E.; Iannitti, David A.; Vrochides, Dionisios

doi:10.1016/j.hpb.2016.06.016

Cited by 33 publications

(48 citation statements)

References 33 publications

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“…Performing the definitive operation immediately (during the 1st 72 h), in the intermediate period (between 72 h and 1.5 months) or in the late period (after1.5 months) from injury, did not have any significant effect on our late biliary morbidity. Similarly, it did not influence postoperative morbidity in Pottakkat et al, 2010 [ 3 ], Patrono et al, 2015 [ 4 ], Bansal et al, 2015 [ 36 ], Huang et al, 2014 [ 38 ], Kirks et al, 2016 [ 83 ], and Perera et al, 2011 [ 84 ], studies. However, most authors advice late repair of LC-BDIs (≤6 weeks) from LC [ 29 , 53 , 85 ]; this allows the abdominal inflammation to subside prior to definitive repair leading to its success [ 50 , 86 ].…”

Section: Discussionmentioning

confidence: 93%

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

Gad

Ayoup

Kamel

et al. 2018

Annals of Medicine and Surgery

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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.

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Section: Discussionmentioning

confidence: 93%

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

Gad

Ayoup

Kamel

et al. 2018

Annals of Medicine and Surgery

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“…Clinical manifestations of bile leak include persistent abdominal tenderness, generalized malaise and anorexia. Bile leak after surgery resulting in intraperitoneal bile collection is typically not contaminated by bacterium and usually does not result in severe bile peritonitis Detecting and locating bile leak may not be easy; patients usually undergo US and CT examinations but these methods can not reliably distinguish bile leak from other postoperative fluid collection such as blood, pus, or serous fluid because of similar densities [44] .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Post-Cholecystectomy Iatrogenic Biliary Injury: A Retrospective Study

Fayek¹,

Ezzat

2020

The Medical Journal of Cairo University

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Background: Preventive strategies and safe surgery are of utmost importance to minimize BDI during cholecystectomy. The importance of frank communication with the patient and accurate documentation cannot be overemphasized. Diagnosis requires a high index of suspicion with focused clinical, biochemical, and radiological examination. Aim of Study: Is to evaluate the best protocol in management of iatrogenic biliary injuries sustained during either laparoscopic or open cholecystectomy. Patients and Methods: 40 patients with iatrogenic bile duct injuries following cholecystectomy (open and Laparoscopic) referred to the

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“…Different opinions exist related to the best moment to carry on the repair, Strasber [9] has suggested to wait 3 months in lesions with confluence lost meanwhile ischemia is delimit, as lesion is always higher than originally appreciated. In the same way, Santibañez [15] considered that repairing should wait 6 to 8 weeks in order to allow inflammation to be limited; on the contrary, recent reports like the ones from Stilling [16] or Kirk [17] concluded that the repair moment of a bilioenteric derivation by itself, did not modify the long term result. Stewart and Way [18] in a multivariate analysis on 307 patients, revealed that a derivation success depends on complete eradication of the abdominal infection, identification of the lesion level through a cholangiography, adequate surgical technique and an experienced biliary team; when these objectives are achieved, repair could be performed at any time with the expectation of a favorable result without any reason to delay the procedure for an arbitrary time [18].…”

Section: Figura 2 Irrigation Of the Bile Duct / C H A: Common Hepamentioning

confidence: 99%

Bile Duct Injuries with Loss of Confluence

Chapa-Azuela¹

2018

IJG

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Introduction: Iatrogenic bile duct injuries (IBDI) with loss of confluence are understood as those where right and left hepatic ducts lose continuity with the common biliary tree. These represent 4% of all IBDI and are considered a very demanding surgical challenge. Study design: This is a series of case in a reference center during an eight-year period (2008-2016), where all patients with IBDI and loss of confluence submitted to any bilioenteric derivation procedure were included. Results: From a total of 11 cases, 10 of them (90.1%) were treated with double bilioenteric derivation and 1 (9%) with a neoconfluence. In 90.9% (n=10) of the patients a percutaneous catheter of biliary drainage was placed before the surgical procedure. Within a 34.5 months follow-up, the initial approach was successful in 54.5% (n=6), meanwhile accumulated achievement was 81.8% (n=9) considering dilatation and remodeling procedures. From this, 18.2% (n=2) are still with stenosis of derivation in a dilatation protocol with percutaneous catheter. Conclusions: Double hepatojejunostomy with transanastomotic stents and management of eventual stenosis with percutaneous dilatation as a first therapeutic intention results in a standardized practice that leads to reasonable results compared with other high volume centers.

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Comparing early and delayed repair of common bile duct injury to identify clinical drivers of outcome and morbidity

Abstract: Background: Outcomes following repair of common bile duct injury (CBDI) are influenced by center and

Cited by 33 publications

References 33 publications

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

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

Diagnosis and Treatment of Post-Cholecystectomy Iatrogenic Biliary Injury: A Retrospective Study

Bile Duct Injuries with Loss of Confluence

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