medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2024, Number 4

<< Back Next >>

Cir Gen 2024; 46 (4)

Surgical treatment of complete bile duct disruption at the National Medical Center of Bajío

Elías ÁKG, Guillen GR

Language: Spanish
References: 25
Page: 224-230
PDF size: 326.75 Kb.


ABSTRACT

Introduction: treatment of complete bile duct disruption with hepatic-jejunostomy is the preferred procedure for reconstruction. The timing of surgical reconstruction has been a topic of constant debate. Experts recommend adequate sepsis control and delaying surgical repair for at least six weeks as it is associated with lower postoperative morbidity rates and a lower risk of stricture. Objective: to analyze the surgical treatment received by patients with a diagnosis of complete bile duct disruption in a third-level hospital. Material and methods: a single-institution database of patients with E1 to E5 bile duct disruption treated surgically from January 2020 to March 2024 was retrospectively consulted. Descriptive statistics were used. Results: 33 patients were included. The mean age was 42 years, and the majority were women. The most frequent disruptions were Strasberg type E3 and E2. The average postoperative follow-up was six months with a complication rate of 27.2%. The time of surgical repair and the development of postoperative complications were compared with a simple logistic regression model. A higher percentage of complications was observed in the intermediate period (66.7%); however, the late repair time > 6 weeks presented an OR of 2.0 (0.34-11.7). Conclusions: more studies and experience are needed in our unit to compare them with national and international statistics, to standardize care with the aim of reducing the risk of complications, since our results have been contradictory.


REFERENCES

  1. Brunt LM, Deziel DJ, Telem DA, Strasberg SM, Aggarwal R, Asbun H, et al. Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surg Endosc. 2020; 34: 2827-2855. doi: 10.1007/s00464-020-07568-7.

  2. Kohn JF, Trenk A, Kuchta K, Lapin B, Denham W, Linn JG, et al. Characterization of common bile duct injury after laparoscopic cholecystectomy in a high-volume hospital system. Surg Endosc. 2018; 32: 1184-1191. doi: 10.1007/s00464-017-5790-8.

  3. Terho P, Sallinen V, Lampela H, Harju J, Koskenvuo L, Mentula P. The critical view of safety and bile duct injuries in laparoscopic cholecystectomy: a photo evaluation study on 1532 patients. HPB (Oxford). 2021; 23: 1824-1829. doi: 10.1016/j.hpb.2021.04.017.

  4. Giuliante F, Panettieri E, De Rose AM, Murazio M, Vellone M, Mele C, et al. Bile duct injury after cholecystectomy: timing of surgical repair should be based on clinical presentation. The experience of a tertiary referral center with Hepp-Couinaud hepatico-jejunostomy. Updates Surg. 2023; 75: 1509-1517. doi: 10.1007/s13304-023-01611-7.

  5. Pesce A, Gaetano SP, Greca L, Puleo S. iatrogenic bile duct injury: impact and management challenges. Clin Exp Gastroenterol. 2019; 12: 121-128. doi: 10.2147/CEG.S169492.

  6. Lau WY, Lai ECH, Lau SHY. Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J Surg. 2010; 80: 75-81. doi: 10.1111/j.1445-2197.2009.05205.x.

  7. Van de Graaf FW, Zarimi I, Stassen LPS, Lange JF. Safe laparoscopic cholecystectomy: a systematic review of bile duct injury prevention. Int J Surg. 2018; 60: 164-172. doi: 10.1016/j.ijsu.2018.11.006.

  8. Khadra H, Johnson H, Crowther J, McClaren P, Darden M, Parker G, et al. Bile duct injury repairs: Progressive outcomes in a tertiary referral center. Surgery. 2019; 166: 698-702. doi: 10.1016/j.surg.2019.06.032.

  9. Kirks RC, Barnes TE, Lorimer PD, Cochran A, Siddiqui I, Martinie JB, et al. Comparing early and delayed repair of common bile duct injury to identify clinical drivers of outcome and morbidity. HPB (Oxford). 2016; 18: 718-725. doi: 10.1016/j.hpb.2016.06.016.

  10. Mercado MA, Domínguez I. Classification and management of bile duct injuries. World J Gastrointest Surg. 2011; 3: 43-48. doi: 10.4240/wjgs.v3.i4.43.

  11. Chapa-Azuela Ó, Ortiz-Higareda V, Etchegaray-Dondé A, Cruz-Martínez R, Iván Hernández-Mejía B, Liceaga E. Tratamiento quirúrgico de las lesiones iatrógenas de la vía biliar. Rev Med Hosp Gen Méx. 2013; 76: 7-14. Disponible en: www.elsevier.es.

  12. Jablonska B, Lampe P. Iatrogenic bile duct injuries: etiology, diagnosis and management. World J Gastroenterol. 2009; 15 (33). doi: 10.3748/wjg.15.4097.

  13. Jajja MR, Laboe A, Hashmi S, Nadeem SO, Sayed BA, Sarmiento JM. Standardizing diagnostic and surgical approach to management of bile duct injuries after cholecystectomy: long-term outcomes of patients treated at a high-volume HPB Center. J Gastrointest Surg. 2021; 25: 2796-2805. doi: 10.1007/s11605-021-04916-3.

  14. Ruiz GF, Ramia AJM, García-Parreño JJ, Figueras J. Lesiones iatrogénicas de la vía biliar. Cir Esp. 2010; 88: 211-221. doi: 10.1016/j.ciresp.2010.03.045.

  15. Balla A, Quaresima S, Corona M, Lucatelli P, Fiocca F, Rossi M, et al. ATOM classification of bile duct injuries during laparoscopic cholecystectomy: analysis of a single institution experience. J Laparoendosc Adv Surg Tech. 2019; 29: 206-212. doi: 10.1089/lap.2018.0413.

  16. Vincenzi P, Mocchegiani F, Nicolini D, Benedetti Cacciaguerra A, Gaudenzi D, Vivarelli M. Bile duct injuries after cholecystectomy: an individual patient data systematic review. J Clin Med. 2024; 13: 4837. doi: 10.3390/jcm13164837.

  17. Moghul F, Kashyap S. Bile duct injury. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available in: https://www.ncbi.nlm.nih.gov/books/NBK546703/

  18. Moldovan C, Cochior D, Gorecki G, Rusu E, Ungureanu FD. Clinical and surgical algorithm for managing iatrogenic bile duct injuries during laparoscopic cholecystectomy: a multicenter study. Exp Ther Med. 2021; 22: 1385. doi: 10.3892/ETM.2021.10821.

  19. Marichez A, Adam JP, Laurent C, Chiche L. Hepaticojejunostomy for bile duct injury: state of the art. Langenbecks Arch Surg. 2023; 408: 107. doi: 10.1007/s00423-023-02818-3.

  20. Dominguez-Rosado I, Sanford DE, Liu J, Hawkins WG, Mercado MA. Timing of surgical repair after bile duct injury impacts postoperative complications but not anastomotic patency. Ann Surg. 2016; 264: 544-553. doi: 10.1097/SLA.0000000000001868.

  21. A European-African HepatoPancreatoBiliary Association (E-AHPBA) Research Collaborative Study management group; Other members of the European-African HepatoPancreatoBiliary Association Research Collaborative. Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study. HPB (Oxford). 2019; 21: 1641-1677. doi: 10.1016/j.hpb.2019.04.003.

  22. Kambakamba P, Cremen S, Mockli B, Linecker M. Timing of surgical repair of bile duct injuries after laparoscopic cholecystectomy: a systematic review. World J Hepatol. 2022; 14: 442-455. doi: 10.4254/wjh.v14.i2.442.

  23. Schreuder AM, Nunez Vas BC, Booij KAC, van Dieren S, Besselink MG, Busch OR, et al. Meta-analysis of the optimal timing for surgical reconstruction of bile duct injury. BJ S Open. 2020; 4: 776-786. doi: 10.1002/bjs5.50321.

  24. Wang X, Yu WL, Fu XH, Zhu B, Zhao T, Zhang YJ. Early versus delayed surgical repair and referral for patients with bile duct injury: a systematic review and meta-analysis. Ann Surg. 2020; 271: 449-459. doi: 10.1097/SLA.0000000000003448.

  25. Iannelli A, Paineau J, Hamy A, Schneck AS, Schaaf C, Gugenheim J. Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie. HPB (Oxford). 2013; 15: 611-616. doi: 10.1111/hpb.12024.




2020     |     www.medigraphic.com