Bile duct injuries during urgent cholecystectomy: analysis of 1320 acute cholecystitis cohort

Abstract

Introduction: Bile duct injuries (BDI) are feared and complex complications during cholecystectomies, adding major morbidity to patients. Literature reviews of BDI are based on retrospective small studies, usually in a non-urgent scenario. Furthermore, there is an expected difference of BDI incidence in cholecystectomies performed during acute cholecystitis (AC) episode due to its major surgical complexity. Our aim is to analyze the BDI incidence from our time-continued cohort of patients with AC. Methods: Single institution retrospective cohort study of AC cases, according to Tokyo Guidelines, from June 2010 until January 2021. Results: A total of 1320 patients were studied and 789 (59,8%) cholecystectomies were performed in this context. We found 20 cases (2,53%) of BDI. 95% of these had an ASA score > 2, median age of 66 years-old and most of them were male. 70% of them were operated by non-training staff with a median surgical time of 110 minutes. 90% of cases underwent laparoscopic surgery with a conversion rate of 15,8%. BDI were statistically associated to major severity grading and longer surgical time (p value <0,05). 19 of BDI were Strasberg Type A and there was only 1 Type E injury.Type A BDI were successfully treated with ERCP in 14 patients, 4 required surgeries and 1 patient percutaneous drainage. Type E BDI patient underwent surgery performing right hepatectomy and biliojejunal derivation. Unfortunately, this patient died during postoperative time being the only mortal case. Conclusions: Our BDI rate during AC episodes is lower than usual reports around 5%. ERCP was the definitive treatment in most patients. Prolonged operative time and severe AC cases should alert surgeons to prevent BDI.