Incidence, diagnostics and management of iatrogenic bile duct injuries: 20 years experience in a high volume centre

Abstract

Background-Aim:The vast majority of bile duct injuries occur in cases of open or laparoscopic cholecystectomy. Numerous reports have demonstrated that the incidence of iatrogenic bile duct injuries (IBDI) has risen from 0.3% to 0.6% since the introduction of laparoscopic cholecystectomy. There are many classifications of iatrogenic bile duct injuries, none of which is universally accepted as each has its own limitation. The aim of the present study is to present the results of our investigation of this clinical topic and to propose a therapeutic algorithm for IBDI, considering the time of treatment, diagnosis and multimodal therapy of these lesions.

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

“…It had a significant negative impact on our late biliary morbidity. Similarly, it was associated with 33.3% early morbidity and 33.3% late stricture in Perrakis et al, 2015 [ 17 ] study. Also, it was significantly associated with late stricture formation in Csendes et al, 1989 [ 66 ] study.…”

“…BDI is considered the most significant complication of LC [ 9 , 20 , 47 ]. The rate of MBDI (type E) of Strasberg's classification vary from 0.08 to 0.6% and is associated with significant morbidity and mortality [ 2 , 17 , 18 , 31 , 48 , 49 ]. Most of the patients with these injuries are referred to tertiary referral centers; either immediately or after unsuccessful re-operation [ 27 , 31 , 50 ].…”

“…The reported both early and late morbidity rates after repair of BIs ranged from 38% to 65% [ 5 , 17 , 24 , 50 , 71 ]. Despite the presence of little literature on the long-term outcomes after surgical reconstruction of MBDIs, the literature rates of long-term post-repair strictures were extremely variable between 4% and 38% [ 5 , 21 , 24 , 31 , 58 , 70 ].…”

“…There are several risk factors for the occurrence of these injuries (I.e. Surgeon inexperience, misinterpretation of biliary anatomy, poor visualization of the surgical field, inflammation, Mirrizi's syndrome, excessive fibrosis in Calot's triangle, adhesions, hemorrhage and lack of intra-operative cholangiogram (IOC) [ 2 , [14] , [15] , [16] , [17] , [18] ].…”

Resultados de correções cirúrgicas de lesões iatrogênicas de vias biliares de um hospital da Amazônia brasileira

“…Estudos recentes evidenciam que em centros de grande volume de colecistectomias laparoscópicas, a presença de lesões iatrogênicas se aproxima daquela obtida com a técnica aberta, com valores entre 0,3 e 0,6% (Linhares et al, 2010;Rystedt et al,2016). Um estudo, com o relato de 5.546 colecistectomias laparoscópicas realizadas ao longo de 20 anos, apenas 5 pacientes (0,09%) foram identificados com lesão da via biliar (Perrakis et al, 2015;Bansal et al, 2015). Outro estudo envolvendo 76 hospitais e um volume de 55.134 cirurgias realizadas ao longo de 5 anos, evidenciou 174 pacientes acometidos, com uma incidência de 0,31% (Rystedt et al, 2016).…”