Management of post-cholecystectomy biliary fistula according to type of cholecystectomy

Sultan, Ahmed; Elnakeeb, Ayman M.; Elshobary, Mohamed; El-Geidi, Ahmed A; Salah, Tarek; Hanafy, Ehab El; Atif, Ehab; Hamdy, Emad; Elebiedy, Gamal K.

doi:10.1055/s-0034-1390747

Cited by 9 publications

(13 citation statements)

References 17 publications

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“…In the field study component of this analysis, we found that >75% of respondents have experienced BDI and/or near-misses at some point during their surgical career. Moreover, the ratio was dependent on the number of life-time cases of cholecystectomies and it reached >80% among surgeons who had performed > 1,000 cases, which was similar to the observation by Massarweh et al [51] .…”

Section: Discussionsupporting

confidence: 88%

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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Section: Discussionsupporting

confidence: 88%

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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“…To ensure standardization among the enrolled centres, these were provided with definitions of pathological obesity (BMI ≥ 30 kg/m 2 ), biliary leakage (presence of bile in abdominal drains lesser than 300–500 per day or intra-abdominal collections) [ 24 , 25 ], bleeding (defined as loss of blood ranging from minor haematomas to significant bleeds that require re-operation or blood transfusions) [ 13 ], iatrogenic lesions according to Strasberg classification and CVS.…”

Section: Methodsmentioning

confidence: 99%

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

et al. 2020

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Background Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. Conclusions The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures. Keywords Cholecystectomy • Critical view of safety • Laparoscopy • Bile duct injuries • Intraoperative bleeding • Laparoscopic training Laparoscopic cholecystectomy (LC) is currently and worldwide considered the gold standard for the treatment of gallbladder lithiasis. Since its introduction, in the early 1990s, this procedure has gained a remarkable consensus until becoming a routine surgical procedure. LC is characterized by a reduction in postoperative pain, hospital stay, and recovery times to normal daily activities, which translates into reduced costs for the national healthcare systems (NHS) [1]. However, this procedure comes with an increased incidence of bile duct injuries (BDI), compared to open cholecystectomy (OC): 0.3% and 0.8% vs 0.2% [2-7]. LC-related BDIs include minor injuries up to complex hilar injuries, as classified by Strasberg et al., in which the and Other Interventional Techniques

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“…The relative number of cholecystectomies has increased as laparoscopic cholecystectomy has become widespread, which in turn has increased rates of bile duct injuries [ 7 – 9 ]. In fact, bile duct injuries were 2-fold higher in laparoscopic cholecystectomies compared to in open technique [ 10 ]. We attributed the inconsistency of our findings compared with the literature to the fact that the code for the procedure at the end of the surgery was mistakenly entered into the system rather than the initial operation, which was reported to TSSI, which our data were based on.…”

Section: Discussionmentioning

confidence: 99%

Financial Aspects of Bile Duct Injuries

2017

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BackgroundMajor bile duct injury is the most worrisome complication of cholecystectomy. There is no detailed data about the incidence or treatment-related costs of bile duct injuries in Turkey. We aimed to determine prevalence and therapeutic costs of patients with major biliary duct injuries managed in our department, and further estimate a projection of these parameters at the national level.Material/MethodsAll patients admitted due to bile duct injury during cholecystectomy from 2011 to 2014 were included. Healthcare costs were calculated by summing of their all treatment-related costs in Istanbul Medical Faculty. We collected 2014–2015 data on number of patients diagnosed with cholecystitis in Turkey, the number of cholecystectomies, and the number of the interventions performed following these initial surgeries, which were obtained from the Turkish Social Security Institution.ResultsForty-nine patients were enrolled and bilioenteric diversion was performed in 39 patients: 20.4% of patients had Bismuth II, 38.8% had Bismuth III, and 40.8% had Bismuth IV biliary stricture. Comparison of stricture types with total costs, days of hospitalization, and outpatient clinic costs revealed significant differences. Mean total cost of corrective surgeries was 9199 TRY. We estimated that 1.5% to 2.4% of patients who underwent cholecystectomy in Turkey have bile duct injury (including 0.3% with major bile duct injury).ConclusionsNew preventive strategies should be used to avoid bile duct injuries, which have a huge financial impact on the national economy.

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Management of post-cholecystectomy biliary fistula according to type of cholecystectomy

Cited by 9 publications

References 17 publications

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

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

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Financial Aspects of Bile Duct Injuries

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