Abstract
Introduction: Biliary duct injury (BDI) is a serious complication during cholecystectomy. Perioperative cholangiography (POC) has recently been generating interest in order to prevent BDI. However, the current literature (including randomized controlled trials) cannot conclude whether POC is protective or not against the risk of BDI. The aim of our study was to investigate whether POC could demonstrate earlier BDI and which criteria are required to make that diagnosis.Methods: We performed a retrospective study between 2005 and 2018 in our French tertiary referral center, which included all patients who had presented following BDI during cholecystectomy.Results: Twenty-two patients were included. Nine patients had POC, whereas 13 did not. When executed, POC was interpreted as normal for three patients and abnormal for six. In this latter group, only two cases had a BDI diagnosed intraoperatively. In other cases, the interpretation was not adequate.Conclusion: BDIs are rare but may reduce patients' quality of life. Our study highlights the surgeon's responsibility to learn how to perform and interpret POC in order to diagnose and manage BDIs and potentially avoid catastrophic consequences.
Highlights
Biliary duct injury (BDI) is a serious complication during cholecystectomy
The current study investigated patients who had a BDI and were referred to our center, in order to highlight the importance of high-quality performance and interpretation of Perioperative cholangiography (POC) in the diagnosis and management of BDI
All patients with BDI as defined in section Materials and Methods consecutively presenting to the study institution were included in the analysis; there were 22 patients treated at Limoges University Hospital for a BDI during a cholecystectomy between January 1, 2005, and December 31, 2018
Summary
Biliary duct injury (BDI) is a serious complication during cholecystectomy. Perioperative cholangiography (POC) has recently been generating interest in order to prevent BDI. BDIs encompass cyst duct leakage, accessory bile duct injuries, or common bile duct injuries, with possible injuries on vascular structures especially the right hepatic artery and the portal vein These injuries can lead to different complications, such as chronic cholangitis and secondary biliary cirrhosis, and potentially the requirement for liver transplantation [3]. The incidence of BDI associated with laparoscopy is 0.25–0.74% for “major lesions,” which affect the main bile duct (MBD), the common hepatic duct, and the right hepatic branch as complete section of biliary duct, Intraoperative Cholangiography Interpretation During Cholecystectomy whereas it is 0.28–1.70% for “minor lesions,” which impact the cystic stump, the cystic duct, and the junction between the cystic duct and the MBD. Recognition of the biliary injury, and by extension its prompt management, is directly correlated with the patient’s future prognosis [5]
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