Evaluating Surgery Outcomes in Patients with Bile Duct Injury Following Cholecystectomy According to Referral Pattern; A Five-Year Study

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Bile duct injury is one of the rare injuries in cholecystectomy that is associated with serious complications. This study aimed to evaluate and compare early and late referral patterns in patients with bile duct injury following cholecystectomy.Methods: In this descriptive cross-sectional study, 64 patients with bile duct injury following cholecystectomy were enrolled into the study according to the inclusion and exclusion criteria. The patients were divided into two groups according to the types of bile duct injuries (based on early and late referral). The postoperative results were evaluated in two groups.Findings: Postoperative complications such as bile duct dilatation (P < 0.001), pruritus (P < 0.001), and cholangitis (P = 0.020) were significantly higher in the late referral group than early referral group. In addition, mean values of aspartate transaminase (AST) and alanine transaminase (ALT) in the late referral group were significantly higher than early referral group, too (P = 0.001 and P = 0.002, respectively).Conclusion: If patients with bile duct injury be diagnosed and referred at early stages (early referral), postoperative complications and duration of complication reduce significantly in these patients.

Keywords


  1. Chuang KI, Corley D, Postlethwaite DA, Merchant M, Harris HW. Does increased experience with laparoscopic cholecystectomy yield more complex bile duct injuries? Am J Surg 2012; 203(4): 480-7.
  2. Duca S, Bala O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford ) 2003; 5(3): 152-8.
  3. Worth PJ, Kaur T, Diggs BS, Sheppard BC, Hunter JG, Dolan JP. Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: A follow-on study. Surg Endosc 2016; 30(5): 1839-46.
  4. Venneman NG, Buskens E, Besselink MG, Stads S, Go PM, Bosscha K, et al. Small gallstones are associated with increased risk of acute pancreatitis: Potential benefits of prophylactic cholecystectomy? Am J Gastroenterol 2005; 100(11): 2540-50.
  5. Behari A, Kapoor VK. Asymptomatic Gallstones (AsGS) - To Treat or Not to? Indian J Surg 2012; 74(1): 4-12.
  6. Fischer CP, Fahy BN, Aloia TA, Bass BL, Gaber AO, Ghobrial RM. Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries. HPB (Oxford) 2009; 11(1): 32-7.
  7. Felekouras E, Petrou A, Neofytou K, Moris D, Dimitrokallis N, Bramis K, et al. Early or Delayed Intervention for Bile Duct Injuries following Laparoscopic Cholecystectomy? A Dilemma Looking for an Answer. Gastroenterol Res Pract 2015; 2015: 104235.
  8. Nordin A, Halme L, Makisalo H, Isoniemi H, Hockerstedt K. Management and outcome of major bile duct injuries after laparoscopic cholecystectomy: from therapeutic endoscopy to liver transplantation. Liver Transpl 2002; 8(11): 1036-43.
  9. Yang WL, Zhang DW, Zhang XC. Clinical analysis of patients with iatrogenic bile duct injury. Hepatobiliary Pancreat Dis Int 2006; 5(2): 283-5.
  10. Rogers EA, Tang SJ, Porter J, Ahmed N. Suspected bile duct injuries and appropriate early referral can reduce chances of litigation. J Miss State Med Assoc 2011; 52(9): 275-7.
  11. 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(3): 544-53.
  12. Patrono D, Benvenga R, Colli F, Baroffio P, Romagnoli R, Salizzoni M. Surgical management of post-cholecystectomy bile duct injuries: referral patterns and factors influencing early and long-term outcome. Updates Surg 2015; 67(3): 283-91.
  13. Martin D, Uldry E, Demartines N, Halkic N. Bile duct injuries after laparoscopic cholecystectomy: 11-year experience in a tertiary center. Biosci Trends 2016; 10(3): 197-201.
  14. Kapoor VK. Bile duct injury repair -- earlier is not better. Front Med 2015; 9(4): 508-11.
  15. Mirza DF, Narsimhan KL, Ferraz Neto BH, Mayer AD, McMaster P, Buckels JA. Bile duct injury following laparoscopic cholecystectomy: referral pattern and management. Br J Surg 1997; 84(6): 786-90.
  16. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 2001; 234(4): 549-58.