Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

Authors

  • Ammar Sabah Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Hussein Ali Alkumasi Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Mohammed Reda AlGhadhban Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq

DOI:

https://doi.org/10.18203/2349-2902.isj20180483

Keywords:

Biliary, Injuries, Laparoscopic cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC), is a new modality of surgery late surfaced late 1980s. Compared with open cholecystectomy, LC is associated with less local pain, shorter hospitalization resulting in an early return to work, and a favourable cosmetic outcome. The aim of this study was to determine the incidence of major biliary injuries associated with LC.

Methods: The patients have been admitted before operation and classical LC was done. Monopolar electrocautery was used. The insertion of postoperative intraperitoneal drain or nasogastric tube depended on the surgeons' preference and opinion. The data was evaluated according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose operations had to be converted from laparoscopic to open.

Results: One hundred and eighty-three (183) patients were initially included in this study. LC was accomplished successfully in one hundred and sixty-two patients (162), twenty-one have been converted to the conventional open method due to sever adhesions or unclear anatomy and they were excluded from this study. Among those who underwent LC, 5(2.73%) had major biliary injuries, another 6 (3.28) had minor injuries and 7 (3.82%) Spillage of Gallstones to the Peritoneal cavity.

Conclusions: Biliary injury is the Achilles’ heel of laparoscopic Cholecystectomy. It can have devastating effects, turning the individual into a "biliary cripple". They mainly result from anatomical anomalies and errors of human judgment and are thus preventable to some extent.

References

Reddick EJ, Olsen DO, Daniell JF, Saye WB, McKernan B, Miller W, et al. Laparoscopic laser cholecystectomy. Laser Medicine and Surgery News and Advances. 1989 Feb;7(1):38-40.

Dubois F, Icard P, Berthelot GA, Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990 Jan;211(1):60.

Kane RL, Lurie N, Borbas C, Morris N, Flood S, McLaughlin B, et al. The outcomes of elective laparoscopic and open cholecystectomies. J Am Coll Surg. 1995 Feb;180(2):136-45.

Super NJ, Sttockmann OT, Dunnegan DL. Laparoscopic cholecystectomy, The new golden standard. Arch Surg. 1992;127:917-23.

Huang ZQ, Huang XQ. Changing patterns of traumatic bile duct injuries: A review of forty years’ experience. World J Gastroenterol. 2002;8:5-12.

Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA. 2003;290: 2168-73.

Boerma D, Rauws EA, Keulemans YC, Bergman JJ, Obertop H, Huibregtse K, et al. Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg. 2001;234:750-7.

Moore DE, Feurer ID, Holzman MD, Wudel LJ, Strickland C, Gorden DL, et al. Long-term detrimental effect of bile duct injury on health-related quality of life. Arch Surg. 2004;139:476-82.

Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy. Ann Surg. 2005;241:786-95.

Gharaibeh KI, Ammari F, Al-Heiss H, Al-Jaberi TM, Qasaimeh GR, Bani-Hani K, et al. Laparoscopic cholecystectomy for gallstones. Ann Saudi Med. 2001;21:312-6.

Olsen DO. Bile duct injuries during laparoscopic cholecystectomy: A decade of experience. J Hepatobiliary Pancreat Surg. 2000;7:35-9.

Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy conversion rates two decades later. JSLS. 2010;14:476-83.

Veen EJ, Bik M, Janssen-Heijnen ML, de Jongh M, Roukema AJ. Outcome measurement in laparoscopic cholecystectomy by using a prospective complication. Int J Qual Health Care. 2008;20:144-51.

Wudel LJ, Jr Wright JK, Pinson CW, Herline A, Debelak J, Seidel S, et al. Bile duct injury following laparoscopic cholecystectomy: a cause for continued concern. Am Surg. 2001;67:557-63.

Balija M, Huis M, Szerda F, Bubnjar J, Stulhofer M. Laparoscopic cholecystectomy accessory bile ducts. Acta Med Croatica. 2003;57:105-9.

Lien HH, Huang CS, Shi MY, Chen DF, Wang NY, Tai FC, et al. Management of bile leakage after laparoscopic cholecystectomy based on etiological classification. Surg Today. 2004;34:326-30.

Schmidt SC, Langrehr JM, Hintze RE, Neuhaus P. Long term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br J Surg. 2005;92:76-82.

Tuveri M, Calò PG, Medas F, Tuveri A, Nicolosi A. Limits and advantages of fundus-first laparoscopic cholecystectomy: Lessons learned. J Laparoendosc Adv Surg Tech A. 2008;18:69-75.

Francoeur JR, Wiseman K, Buczkowski AK, Chung SW, Scudamore CH. Surgeons’ anonymous response after bile duct injury during cholecystectomy. Am J Surg. 2003;185:468-75.

Hugh TB. New strategies to prevent laparoscopic bile duct injury surgeons can learn from pilots. Surg. 2002;132:826-35.

Slater K, Strong RW, Wall DR, Lynch SV. Iatrogenic bile duct injury: the scourge of laparoscopic cholecystectomy ANZ J Surg. 2002;72:83-8.

Litwin DE, Cahan MA. Laparoscopic cholecystectomy. Surg Clin North Am. 2008;88:1295-313.

Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA. 2003;289:1639-44.

Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP. Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg. 2001;136:1287-92.

Strasberg SM, Brunt M. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010;211:132-8.

Flum DR, Flowers C, Veenstra DL. A cost-effectiveness analysis of intraoperative cholangiography in the prevention of bile duct injury during laparoscopic cholecystectomy. J Am Coll Surg. 2003;196:385-93.

Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001;234:549-59.

Massarweh NN, Devlin A, Elrod JA. Surgeon knowledge, behavior, and opinions regarding intraoperative cholangiography. J Am Coll Surg. 2008;207:821.

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Published

2018-02-26

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Original Research Articles