Rising incidence of iatrogenic bile duct injuries following cholecystectomy: a cause of worry

Abstract

Inaccurate learning and understanding of biliary anatomy mainly lead to iatrogenic bile duct injuries (IBDI) and such complications are mostly the postoperative result of laparoscopic cholecystectomy. Minor bile leakage of aberrant ducts and complete occlusion of the main duct or a branch (often an aberrant right duct) are possibilities for many IBDIs. In addition, bile duct strictures and biliary leakages are severe long-term complications after laparoscopic cholecystectomy1. A well-established thought is that any postoperative change observed after laparoscopic cholecystectomy suggests possible damage to the biliary tract. Injuries related to the biliary tract are associated with high morbidity, death rate, and prolonged hospitalization. Bile duct injury with an estimated incidence of 0.4%–1.5% is a dangerous complication of cholecystectomy2. and with the introduction of laparoscopic cholecystectomy as the surgical treatment of choice for symptomatic cholelithiasis, the incidence of IBDI—which represents the most dramatic complications after open or laparoscopic cholecystectomy increased3. Comparing the incidence of IBDI in open cholecystectomy and laparoscopic cholecystectomy, despite increasing experience, IBDI incidence is still elevated in LC which is up to 3% compared with the rate of clinically relevant bile leaks after conventional open cholecystectomy ranging between 0.1 and 0.54–6. According to studies, the incidence of bile duct injuries after laparoscopic cholecystectomy hiked as high as 1% with a conservative estimate being 1 in 1000 cases (0.1%)7. Successful treatment is characterized by early diagnosis, control of the intra-abdominal fluid collection and infection, nutritional balance, multidisciplinary approach, and surgical repair by an experienced surgeon in biliary reconstruction. The top most recommended strategies to classify and initially diagnose and treat IBDI are endoscopic techniques, for example biliary stent placement, biliary sphincterotomy, and nasobiliary drainage. Surgical intervention, precisely Roux-en-Y hepaticojejunostomy, is the most feasible treatment for patients with complete dissection or obstruction of the bile duct. Even though eventually most bile duct injuries require surgical reconstruction but the role of the interventional radiologist in the initial diagnosis, classification, and management of IBDIs is often crucial for achieving a successful outcome. Long-term results are most important in the assessment of the effectiveness of IBDI treatment. Apart from that, adequate diagnosis and treatment of IBDI may avoid many serious complications and improve the quality of life of our patients, therefore, management of these injuries often requires an experienced multidisciplinary team (including interventional radiology, gastroenterology, and surgery), they are best handled in a tertiary referral center. Ethical approval None. Sources of funding None. Author contribution O.H.S., S.I.A., R.M.A., and M.K.: wrote the manuscript. ,O.H.S. and S.I.A.: review editing, formatting, and referencing, Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Maham Khan.