MANAGEMENT OF BILE DUCT INJURY IN A REFERRAL CENTER, 10 YEARS OF EXPERIENCE

Abstract

Abstract Introduction Bile duct injury represents major morbidity and mortality, and in the last two decades in which laparoscopy cholecystectomy has been universally available several factors associated with bile duct injury have been described: one of them being the surgeon's training and experience in laparoscopic cholecystectomy. Some authors have reported that the training curve stabilizes the risk of bile duct injury from 1.7 to 0.17% by procedure number 50. Given that most surgical residency programs don't have enough experience in laparoscopy, this likely contributes to the development of bile duct injury. Therefore, it is important to elucidate the risk factors for bile duct injury in our country. Methods In a referral center we collected the data from 10 years of experience in bile duct repair for bile duct injury. The clinical records for 83 patients were obtained and analyzed. Results High-quality hepaticojejunostomy was performed in all 117 cases, 89.8% open, 8.5% laparoscopic and 1.7% was converted from laparoscopic to open. In 41% of patients, partial resection of the IV segment was necessary. the main post-operatory complication was surgical site infection in 19.6%, overall mortality was 3.4%. according to McDonald Classification for Group A 56.4%, Group B 28.2%, Group C 10.2%, Group D 5.2%, in long-term follow-up. Conclusions Surprisingly, the open cholecystectomy was the most common procedure associated with bile duct injury in our population. Postoperative injury detection was the most frequent, and the most common injury location was near the confluence. We obtained good long-term results even the type of injuries. The disproportion between training centers and hospitals all around the country may impact these results due to the lack of experience of the young surgeons that have only had training in laparoscopic surgery and the lack of universal laparoscopic availability for emergencies. The patients that suffer from this complication are of middle age, and there is a significant disproportion between males and females, with females being the most affected group. It has an impact on their quality of life. High-quality hepaticojejunostomy with Hepp-couinaud technique provides good long-term results, with no difference between the 1–5 year and the 6–10 year groups. The segment IV hepatectomy represents a good option to access the hilar plate. It is important to continue to expose surgeons during their residencies to open cholecystectomy. Prevention is the cheapest and safest way to decrease the incidence of bile duct injury. The implementation of high-volume centers such as ours is important to bring early and high-quality solutions to problems like these.