Bile Duct Injury In Laparoscopic Cholecystectomy Research Articles

Evaluating the Impact of Surgical Occurrence of Bile Duct Injuries in Laparoscopic Cholecystectomy- A Retrospective Observational study

Background: Laparoscopic cholecystectomy (LC) is the gold standard for treating gallstone disease, offering numerous benefits over traditional open cholecystectomy. However, bile duct injuries (BDIs) are a significant complication, contributing to substantial morbidity and mortality. This study aims to evaluate the incidence, causes, risk factors, treatments, and outcomes of BDIs in laparoscopic cholecystectomy in Bangladesh. Material & Methods: This retrospective observational study was conducted at the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University, Al-Manar Hospital Limited, and Abeer General Hospital, Dhaka, Bangladesh. During this period, a total of 1255 complete hospital records of laparoscopic cholecystectomy conducted over the last 5 years at the study hospital were selected for the study following inclusion and exclusion criteria. Results: Out of laparoscopic cholecystectomy cases, 20 (1.64%) patients experienced BDIs. The most common cause of BDI was clipping or transection of the duct (33.33%), followed by mistaken anatomy (22.22%) and ischemic injury due to clip (18.52%). Acute cholecystitis was the most prevalent risk factor (37.04%). Standard laparoscopic cholecystectomy was performed in 83.33% of BDI cases, with the remaining 16.67% undergoing single-incision laparoscopic cholecystectomy. The majority of patients (74.07%) had no complications after BDI treatment, while 18.52% experienced minor complications, 5.56% had major complications, and 1.85% resulted in mortality. Conclusion: This study highlights the importance of meticulous surgical technique, early recognition, and appropriate management of bile duct injuries in laparoscopic cholecystectomy. By continually refining our understanding of the factors contributing to BDIs and implementing evidence-based strategies to prevent and manage this complication, we can optimize patient outcomes and ensure the highest standards of care in laparoscopic cholecystectomy.

Bile duct injury in laparoscopic cholecystectomy with a posterior infundibular approach

Aims: Bile duct injury (BDI) in laparoscopic cholecystectomy (LC) has a significant impact on morbidity and mortality. Although the critical view of safety (CVS) concept is the most widely supported approach to prevent BDI, alternative approaches are used as well. The aim was to evaluate the incidence, severity, and management of bile duct injury in LC, using a posterior infundibular approach. Methods: This retrospective, monocentric cohort study includes patients who underwent LC for gallstone disease. Data were collected in a prospectively maintained database. Patients with BDI were identified and were analyzed in-depth. Results: Between 1999 and 2018, 8389 consecutive patients were included (M/F 3288/5101; mean age 55 (standard deviation; SD ± 17) years). Mean length of postoperative hospital stay was two days (SD ± 4). Fourteen patients died after LC and 21 patients were identified with BDI. Seventeen BDI (81%) patients were managed minimally invasive (14 endoscopic, 3 laparoscopic), and 4 patients via laparotomy (3 hepaticojejunostomy, 1 primary suture). Severe complications (Clavien-Dindo ≥3) after BDI repair were observed in 6 patients. There was no BDI-related mortality. Median follow-up time was 113 months (range 5–238). Conclusion: A posterior infundibular approach in LC was associated with a low incidence of BDI and no BDI-related mortality.

Analysis of risk factors for bile duct injury in laparoscopic cholecystectomy in China: A systematic review and meta-analysis.

Background:To explore the risk factors of bile duct injury in laparoscopic cholecystectomy (LC) in China through meta-analysis.Methods:The study commenced with a search and selection of case–control studies on the risk factors for bile duct injury in LC in China using the following databases: PubMed, EMBASE, ScienceNet.cn, CNKI, Wanfang Data, and VIP. Data were extracted from the collected documents independently by 2 researchers, following which a meta-analysis of these data was performed using Revman 5.3.Results:The compilation of all data from a total of 19 case–control studies revealed that among 41,044 patients, 458 patients experienced bile duct injury in LC, accounting for the incidence rate of 1.12% for bile duct injury. The revealed risk factors for bile duct injury were age (≥40 years) (odds ratio [OR] = 6.23, 95% CI [95% confidence interval]: 3.42–11.33, P < .001), abnormal preoperative liver function (OR = 2.01, 95% CI: 1.50–2.70, P < .001), acute and subacute inflammation of gallbladder (OR = 8.35, 95% CI: 5.32–13.10, P < .001; OR = 4.26, 95% CI: 2.73–6.65, P < .001), thickening of gallbladder wall (≥4 mm) (OR = 3.18, 95% CI: 2.34–4.34, P < .001), cholecystolithiasis complicated with effusion (OR = 3.05, 95% CI: 1.39–6.71, P = .006), and the anatomic variations of the gallbladder triangle (OR = 11.82, 95% CI: 6.32–22.09, P < .001). However, the factors of gender and overweight (body mass index ≥ 25 kg/m2) were not significantly correlated with bile duct injury in LC.Conclusions:In the present study, age (≥40 years), abnormal preoperative liver function, gallbladder wall thickening, acute and subacute inflammation of the gallbladder, cholecystolithiasis complicated with effusion, and anatomic variations of the gallbladder triangle were found to be closely associated with bile duct injury in LC.

Artificial Intelligence for Surgical Safety: Automatic Assessment of the Critical View of Safety in Laparoscopic Cholecystectomy Using Deep Learning.

To develop a deep learning model to automatically segment hepatocystic anatomy and assess the criteria defining the critical view of safety (CVS) in laparoscopic cholecystectomy (LC). Poor implementation and subjective interpretation of CVS contributes to the stable rates of bile duct injuries in LC. As CVS is assessed visually, this task can be automated by using computer vision, an area of artificial intelligence aimed at interpreting images. Still images from LC videos were annotated with CVS criteria and hepatocystic anatomy segmentation. A deep neural network comprising a segmentation model to highlight hepatocystic anatomy and a classification model to predict CVS criteria achievement was trained and tested using 5-fold cross validation. Intersection over union, average precision, and balanced accuracy were computed to evaluate the model performance versus the annotated ground truth. A total of 2854 images from 201 LC videos were annotated and 402 images were further segmented. Mean intersection over union for segmentation was 66.6%. The model assessed the achievement of CVS criteria with a mean average precision and balanced accuracy of 71.9% and 71.4%, respectively. Deep learning algorithms can be trained to reliably segment hepatocystic anatomy and assess CVS criteria in still laparoscopic images. Surgical-technical partnerships should be encouraged to develop and evaluate deep learning models to improve surgical safety.

Factors leading to loss of patency after biliary reconstruction of major laparoscopic cholecystectomy bile duct injuries: an observational study with long-term outcomes

BackgroundSmall sample size and a lack of standardized reporting for patients requiring reconstruction for laparoscopic cholecystectomy bile duct injuries (LC-BDI) have limited investigation of factors contributing to loss of patency. MethodsUsing a prospective database, patient characteristics, pre-repair investigations, Strasberg-Bismuth level of injury, timing of reconstruction and postoperative complications were compared in successful index reconstruction and revision patients. Multivariate analysis was performed to determine independent predictors of loss of patency. ResultsOf 131 patients analysed, 103 had a successful index reconstruction and 28 required revision. There were no statistically significant differences in patient characteristics between the two groups. Days to referral and reconstruction were significantly different (p < 0.001, p = 0.001). Patients with incomplete biliary imaging more often required a revision (p < 0.001). The only independent predictor of loss of patency was incomplete depiction of the biliary tree prior to initial reconstruction (p = 0.035, OR 10.131, 95% CI 1.180–86.987). Primary and secondary patency were 98.1% and 96.4%, respectively with no differences in 30-day complications. ConclusionsIncomplete depiction of LC-BDI before index reconstruction was independently associated with loss of patency requiring revision. Despite the complexity of repeat biliary reconstruction, outcomes in an HPB unit were similar to that of an index reconstruction.

Loss of patency after surgical repair of major laparoscopic cholecystectomy bile duct injuries: Contributing factors and long term outcomes

Loss of patency after surgical repair of major laparoscopic cholecystectomy bile duct injuries: Contributing factors and long term outcomes

Safe laparoscopic cholecystectomy: a systematic review of bile duct injury prevention

Background: Since the introduction of laparoscopic cholecystectomy (LC), a substantial increase in bile duct injury (BDI) incidence was noted. Multiple methods to prevent this complication have been developed and investigated. The most suitable method however is subject to debate. In this systematic review, the different modalities to aid in the safe performance of LC and prevent BDI are delineated. Methods: A systematic search for articles describing methods for the prevention of BDI in LC was conducted using EMBASE, Medline, Web of science, Cochrane CENTRAL and Google scholar databases from inception to 29 march 2017. Results: 89 studies were included in this systematic review. Overall, BDI preventive techniques can be categorized as dedicated surgical approaches (Critical View of Safety (CVS), fundus first, partial laparoscopic cholecystectomy), supporting imaging techniques (intraoperative cholangiography, intraoperative ultrasonography, fluorescence imaging) and others. Dedicated surgical approaches demonstrate promising results, yet limited research is provided. Intraoperative cholangiography and ultrasonography demonstrate beneficial effects in BDI prevention, however the available evidence is low. Fluorescence imaging is in its infancy, yet this technique is demonstrated to be feasible and larger trials are in preparation. Conclusion: Given the low sample sizes and suboptimal study designs of the studies available, it is not possible to recommend a preferred method to prevent BDI. Surgeons should primarily focus on proper dissection techniques, of which CVS is most suitable. Additionally, recognition of hazardous circumstances and knowledge of bail-out techniques is critical to complete surgery with minimal risk of injury to the patient.

Prevention of bile duct injury: the case for incorporating educational theories of expertise.

Over 700,000 laparoscopic cholecystectomies are performed yearly in the US. Despite multiple advantages of laparoscopic surgery, the increased rate of bile duct injury (BDI) compared to the traditional, open approach to cholecystectomy remains problematic. Due to the seriousness of bile duct injury, the time has come for an aggressive educational campaign to better train laparoscopic surgeons in order to reduce the incidence of this life-threatening and expensive complication. We performed a literature review of what is currently known about the causes of bile duct injury during laparoscopic cholecystectomy. Based on these reviews, we identified educational theories of expertise that may be relevant in understanding variable rates of BDI between surgeons. Finally, we applied educational theories of expertise to the problem of BDI in laparoscopic cholecystectomy to propose how to develop and design an effective educational approach for the prevention of BDI. Multiple studies demonstrate that the primary causes of BDI during laparoscopic cholecystectomy are non-technical. Additionally, there exists a learning curve in which the rates of BDI are higher in a surgeon's earlier cases compared to later cases and that some surgeons perform laparoscopic cholecystectomy with significantly fewer injuries than others. Educational theories indicate that interventions that optimize novice to expert development require (1) revealing expert knowledge to novices and (2) scaffolding the mental habits of expert-like learners. BDI is an appropriate target for the application of educational theories of expertise. Designing better educational interventions for the prevention of BDI will require uncovering the hidden knowledge of expert surgeons and incorporating the processes of reinvestment and progressive problem solving that are inherent to expert performance.

Treatment of Major Laparoscopic Bile Duct Injury: A Long-Term Follow-up Result

The goal of this study is to present the multiple institutions experience comparing the outcome of management between initial laparoscopic cholecystectomy (LC) surgeon and specialist as well as the outcome of different operative procedures to major bile duct injury (BDI) after LC. We have retrospectively collected data of 77 cases of perioperatively detected major BDI in LC at 15 general surgical institutions from 1997 to 2007. We classified 42 cases treated by an experienced biliary surgeon as Group A and 35 cases treated by the initial LC surgeon as Group B. Forty-eight cases were treated with duct-to-duct anastomosis as Group C and 29 cases were treated with Roux-en-Y choledochojejunostomy as Group D. The median duration of follow-up was 62 months. The outcome of groups was compared. In Group A, 7 of 42 (16.7%) patients developed a failure. Two of seven (28.6%) patients were treated by a secondary operation. In Group B, 24 of 35 (68.6%) patients developed a failure. Seventeen of 24 (70.8%) patients were treated by a secondary operation. One of 35 (2.85%) patients died. The significant differences were observed in failure and secondary operations (16.7 vs 68.6%, P < 0.01 and 28.6 vs 70.8%, P < 0.01). There is no significant difference Group C and Group D in failure rate (28.5 vs 11.7%, P > 0.05). A multiple institutional cooperative methodology between the local surgical institution and tertiary care centers provided a good way to limit further operations, failure. The reconstructive strategy is important and should be selected according to the type of injury and the diagnosed status of major BDI.

Bile duct injuries during open and laparoscopic cholecystectomy in the laparoscopic era: alarming trends

After the introduction of laparoscopic cholecystectomy (LC), scientific discussion and concern about iatrogenic bile duct injuries (BDIs) have been limited mostly to BDIs sustained in LC, while BDIs sustained in open cholecystectomy (OC) and in all cholecystectomies have not been the center of attention. This study included all patients who sustained BDI in OC or LC in southwest Finland between 1997 and 2007. All data were collected retrospectively in June 2009. Altogether 75 BDIs were encountered in a total of 8349 cholecystectomies, for an overall incidence of 0.90%. Twenty BDIs (15 Amsterdam type A and 5 type B, C, or D) occurred in the 1616 OCs (incidence rate=1.24%), and 55 (26 type A and 29 type B, C, or D) in the 6733 LCs (incidence rate=0.82%). All the BDIs in the OCs were missed while 11/29 of the major BDIs in the LCs were detected at the time of surgery. Fifty-four of 59 type A, B, and C BDIs could be treated endoscopically. In the laparoscopic era, OC is associated with a high number of BDIs, if minor BDIs are included. Excluding some major LC BDIs, BDIs are, as a rule, missed at the time of surgery. More than 90% of Amsterdam types A, B, and C BDIs can be treated endoscopically, whereas type D BDI remains an absolute indication for surgery.

Risk Factors for Litigation Following Major Transectional Bile Duct Injury Sustained at Laparoscopic Cholecystectomy

Bile duct injuries after laparoscopic cholecystectomy often cause long-term morbidity, with a number of patients resorting to litigation. The present study aimed to analyze risk factors for litigation and to quantify the subsequent medicolegal burden. A total of 67/106 patients (26 male) with major laparoscopic cholecystectomy bile duct injuries (LCBDI) and a minimum 2-year follow-up, replied to a questionnaire covering patient perception toward the complication, physical/psychological recovery, and subsequent litigation. These data were collated with prospectively collected data related to the LCBDI and subsequent management, and a multivariate regression model was designed to identify potential risk factors associated with litigation. Most patients felt they had been inadequately informed prior to surgery [47/67 (70%)] and after the LCBDI [50/67 (75%)], and a majority remained psychologically traumatized at the time of evaluation [50/67 (75%)]. Of these, 22 patients had started litigation by means of a "letter of demand" (LOD; n=10) or prosecution (n=12). Nineteen (19/22%) cases have been closed in favor of the plaintiff. There was no difference between the awards for LOD versus prosecution cases, and average compensation was £40,800 versus £89,875, respectively (p=n.s). On multivariate analysis, age<52years (p=0.03), associated vascular injury (p=0.014), immediate nonspecialist repair (p=0.009), and perceived incomplete recovery following LCBDI (p=0.017) were identified as independent predictors for possible litigation. On the basis of the present study, nearly one third of patients with major transectional LCBDI are likely to resort to litigation. Younger patients and those in whom repair is attempted prior to specialist referral are likely to initiate litigation.

Repair of laparoscopic cholecystectomy bile duct injuries: A ten-year experience at the University of Toronto

Repair of laparoscopic cholecystectomy bile duct injuries: A ten-year experience at the University of Toronto

Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures.

Referral pattern and management of post laparoscopic cholecystectomy bile duct injuries: [formula omitted]. The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK

Referral pattern and management of post laparoscopic cholecystectomy bile duct injuries: [formula omitted]. The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK