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Bile duct injuries during laparoscopic cholecystectomies: an 11-year population-based study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Iatrogenic bile duct injuries (BDI) following laparoscopic cholecystectomy (LC) result in major morbidity and incidental mortality. There is a lack of unselected population-based cross-sectional studies on the incidence, management, and outcomes of BDI. We hypothesised that due to improved imaging capabilities and collective laparoscopic experience, BDI incidence will decrease over the study period and compare favourably with contemporary literature.

Methods

After IRB approval, all cholecystectomies performed at national public healthcare facilities between 2008 and 2018 were retrospectively reviewed. BDIs were classified according to the Strasberg classification. The follow-up period ranged from 36 to 156 months.

Results

A total of 241 BDIs of 29,739 laparoscopic cholecystectomies (LC) resulted in overall, minor, and major BDI incidence rates of 0.81%, 0.68%, and 0.13%, respectively. No significant decline in the BDIs was noted during the study period. Drainage in 66 (42.6%) and cases ERCP stent placement in 65 (41.9%) cases were equally used in Strasberg A lesions. Suture over T-tube in 20 (42.6%) and ERCP stenting in 19 (40.4%) cases were used in Strasberg D lesions. Roux-en-Y hepatojejunostomy (RYHJ) was performed in 30 (88.9%) of Strasberg E lesions. There were 27 (11.2%) patients with long-term bile duct strictures after BDI management. The overall mortality rate of BDIs and subsequent complications was 4.6%.

Conclusions

The annual incidence of iatrogenic bile duct injury over an 11-years’ time after laparoscopic cholecystectomy did not decline significantly. We noted an overall BDI incidence of 0.81% comprising of 0.68% minor and 0.13% of major lesions. The management of injuries met contemporary guidelines with comparable outcomes.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Flum DR, Cheadle A, Prela C, et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA. 2003;290(16):2168–73.

    Article  CAS  PubMed  Google Scholar 

  2. Waage A, Nilsson M. A population-based study of 152 776 cholecystectomies in the Swedish inpatient registry. Arch Surg. 2006;141(12):1207–13.

    Article  PubMed  Google Scholar 

  3. Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: treatment and outcome from a National perspective. World J Surg. 2016;40:73–80.

    Article  PubMed  Google Scholar 

  4. Pucher PH, Brunt LM, Davies N, et al. SAGES Safe Cholecystectomy Task Force. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175–83.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pucher PH, Brunt LM, Davies N, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175–83.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fong ZV, Pitt HA, Strasberg SM, et al. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. J Am Coll Surg. 2018;226(4):568–76 (e561).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rystedt J, Montgomery A, Persson G. Completeness and correctness of cholecystectomy data in a national register–Gallriks. Scand J Surg. 2014;103(4):237–44.

    Article  CAS  PubMed  Google Scholar 

  8. Karvonen J, Gullichsen R, Laine S, et al. Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution. Surg Endosc. 2007;21(7):1069–73. https://doi.org/10.1007/s00464-007-9316-7 (Epub 2007 May 19).

    Article  PubMed  Google Scholar 

  9. Krähenbühl L, Sclabas G, Wente M, et al. Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland. World J Surg. 2001;25:1325–30.

    Article  PubMed  Google Scholar 

  10. Halbert C, Pagkratis S, Yang J, et al. Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc. 2016;30:2239–43.

    Article  PubMed  Google Scholar 

  11. Booij KAC, de Reuver PR, van Dieren S, et al. Long-term impact of bile duct injury on morbidity, mortality, quality of life, and work related limitations. Ann Surg. 2018;268:143–50.

    Article  PubMed  Google Scholar 

  12. Ismael HN, Cox S, Cooper A, et al. The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford). 2017;19:352–8.

    Article  PubMed  Google Scholar 

  13. Christou N, Roux-David A, Naumann DN, et al. Bile duct injury during cholecystectomy: necessity to learn how to do and interpret intraoperative cholangiography. Front Med (Lausanne). 2021;8: 637987. https://doi.org/10.3389/fmed.2021.637987.

    Article  PubMed  Google Scholar 

  14. de’Angelis N, Catena F, Memeo R, et al. WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg. 2020;16:30. https://doi.org/10.1186/s13017-021-00369-w.

    Article  Google Scholar 

  15. Kimura T, Suzuki K, Umehara Y, et al. Features and management of bile leaks after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg. 2005;12:61–4.

    Article  PubMed  Google Scholar 

  16. Lillemoe KD, Melton GB, Cameron JL, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg. 2000;232:430–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chathadi KV, Chandrasekhara V, Acosta RD, et al. The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc. 2015;81(4):795–803.

    Article  PubMed  Google Scholar 

  18. Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev. 2013;6:CD005641.

    Google Scholar 

  19. A European-African HepatoPancreatoBiliary Association (E-AHPBA) Research Collaborative Study management group, et al. Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy—an E-AHPBA multi-center study. HPB (Oxford). 2019;21(12):1641–7. https://doi.org/10.1016/j.hpb.2019.04.003.

    Article  Google Scholar 

  20. Tornqvist B, Stromberg C, Persson G, Nilsson M. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ. 2012;345: e6457.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Alvarez F, de Santibañes M, Palavecino M, et al. Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg. 2014;101:677–84.

    Article  CAS  PubMed  Google Scholar 

  22. Rystedt JML, Wiss J, Adolfsson J, et al. Routine versus selective intraoperative cholangiography during cholecystectomy: systematic review, meta-analysis and health economic model analysis of iatrogenic bile duct injury. BJS Open. 2021;5(2):zraa032. https://doi.org/10.1093/bjsopen/zraa032.

    Article  PubMed  Google Scholar 

  23. Mangieri CW, Hendren BP, Strode MA, et al. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc. 2019;33(3):724–30. https://doi.org/10.1007/s00464-018-6333-7.

    Article  PubMed  Google Scholar 

  24. Pottakkat B, Vijayahari R, Prakash A, et al. Factors predicting failure following high bilio-enteric anastomosis for post-cholecystectomy benign biliary strictures. J Gastrointest Surg. 2010;14:1389–94.

    Article  PubMed  Google Scholar 

  25. Schreuder AM, Busch OR, Besselink MG, et al. Long-Term Impact of Iatrogenic Bile Duct Injury. Dig Surg. 2020;37(1):10–21.

    Article  PubMed  Google Scholar 

  26. Costamagna G, Tringali A, Perri V, et al. Endotherapy of postcholecystectomy biliary strictures with multiple plastic stents: long-term results in a large cohort of patients. Gastrointest Endosc. 2020;91(1):81–9. https://doi.org/10.1016/j.gie.2019.05.042 (Epub 2019 Jun 5).

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank all colleagues for suggestions and commenting the manuscript.

Funding

This study received no funding.

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Authors and Affiliations

  1. Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Sütiste Tee 19, Tallinn, Estonia

    Arvo Reinsoo & Peep Talving

  2. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia

    Arvo Reinsoo, Ülle Kirsimägi, Urmas Lepner & Peep Talving

  3. Faculty of Medicine, University of Tartu, Tartu, Estonia

    Liis Kibuspuu & Karita Košeleva

Authors
  1. Arvo Reinsoo
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  2. Ülle Kirsimägi
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  3. Liis Kibuspuu
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  6. Peep Talving
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Corresponding author

Correspondence to Arvo Reinsoo.

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Conflict of interest

None of the authors declare no conflicts of interest.

Ethical approval

The study was approved by the Research Ethics Committee of the University of Tartu ClinicalTrials.gov Identifier: NCT05479227.

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Reinsoo, A., Kirsimägi, Ü., Kibuspuu, L. et al. Bile duct injuries during laparoscopic cholecystectomies: an 11-year population-based study. Eur J Trauma Emerg Surg 49, 2269–2276 (2023). https://doi.org/10.1007/s00068-022-02190-9

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  • DOI: https://doi.org/10.1007/s00068-022-02190-9

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