Delayed referral to specialist centre increases morbidity in patients with bile duct injury (BDI) after laparoscopic cholecystectomy (LC)

Abstract

A late referral was associated with a higher incidence of post-treatment complications, greater need for invasive procedures and a longer recovery period. These observations support the need for early patient transfer to a tertiary institution following BDI.

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

“…In our study, referral time to our center after injury diagnosis had no significant impact on early complications or late biliary morbidity; despite the trend towards occurrence of significant early complications with longer time, similarly, In a multivariate analysis done by Lillemoe et al, 2000 [ 72 ], the interval until admission to a tertiary hepatobiliary center had no significant impact on the outcome. In contrast, it independently affected short- and long-term outcomes in Bansal et al, 2015 [ 36 ] study and was independent predictor of worse outcome in De Reuver et al, 2007 [ 29 ] and Martinez-Lopez et al,2017 [ 52 ] studies, also, longer delay of referral (>3 months) from index surgery was associated with poor outcome in AbdelRafee et al, 2015 [ 5 ] study.…”

“…Most of the patients with these injuries are referred to tertiary referral centers; either immediately or after unsuccessful re-operation [ 27 , 31 , 50 ]. Higher rates of successful repair have been reported in these referral centers [ 2 , 19 , 25 , 38 , 48 , 51 , 52 ]; so, it is highly recommended for patients to be referred early to these centers [ 18 ]. Similarly, as our center is a tertiary referral hepatobiliary one, 68 of the 69 patients were referred to us from other hospitals either before the definitive procedure (66 patients) or after it (2 patients) where our long-term success rate reached 82.6%.…”

“…Similarly, we found a significant correlation between the higher level of injury and co-vascular injuries (P = 0.000). The rate of concomitant RT-HA injury was variable between 7% and 40% in different series [ 2 , 8 , 18 , 30 , 31 , 52 , 59 , [75] , [76] , [77] ]; depending on the cohort of patients under evaluation and whether angiographic assessment was done routinely [ 53 ]. However, it was less (8.6%) in our work; and this lower rate may be due to the nonroutine performance of pre-operative CT angiography or intra-operative doppler us as they were performed only when vascular lesions were suspected.…”

Post-cholecystectomy acute injury: What can go wrong?

“…Many reports have described the mechanisms and safety measures to be observed during laparoscopic cholecystectomy to prevent this catastrophe 11121314. Very few reports have discussed the occurrence of bile duct injuries occurring after open cholecystectomy, probably, due to the fewer number of open procedures being performed 491516. Open cholecystectomy is usually reserved as a salvage procedure.…”

Surgical management for bile duct injury

“…Nondefinitive surgical exploration and the implementation of definitive repair surgery with inappropriate timing are ubiquitous (12,27). Moreover, delayed referral to a specialist center increases morbidity (28). In China, the evidence-based Practice Guideline for Diagnosis and Treatment of BDI was published by the Biliary Surgery Group of Surgery Branch of Chinese Medical Association, with the purpose of reducing the incidence of BDI as well as promoting its optimal diagnosis and treatment (29).…”