Real-Life Situation Of Bile Duct Injury Management: Challenges And Lessons From A Tertiary Care Center
), Apriliana Adhyaksari(2), See Young Lee(3), Thawee Ratanachu-ek(4), Stefanus Satrio Ranty(5), Ari Prasetyo(6), Aritantri Darmayani(7), Didik Prasetyo(8), Anung Notonugroho(9),
(1) Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta
(2) Subspecialist Program Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta / Internal Medicine Department, Faculty of Medicine Pembangunan Nasional Veteran University, Jakarta
(3) Department of Internal Medicine, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
(4) Rajavithi Digestive Endoscopy Center, Department of Surgery Rajavithi Hospital, Bangkok, Thailand
(5) Subspecialist Program Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta
(6) Subspecialist Program Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta
(7) Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta
(8) Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta
(9) Division of Digestive Surgery, Department of Surgery, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta
Corresponding Author
Abstract
Background: Bile duct injury (BDI) is a serious complication of cholecystectomy, particularly with the widespread adoption of laparoscopic cholecystectomy (LC). Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. This study evaluates reallife clinical experiences in managing post-cholecystectomy BDIs in Central Java, Indonesia. We aim to discuss the prevention of BDI further and find out the most effective management and timing of interventions for BDI based on these analyses.
Methods: Twenty-seven cases with iatrogenic BDI following cholecystectomy were classified according to BDI Strasberg classification, repair procedures, mortality and success rate procedures, onset of BDI, and timing of repair procedures. The correlation analyses were performed using the Contingency Coefficient Correlation Test.
Results: Of the 27 patients, BDIs were detected in 33.3% of patients within two weeks of surgery. Major BDIs (Strasberg E) often required biliodigestive surgery, with variable outcomes. The overall mortality rate was 29.6%, mainly due to biliary sepsis. ERCP success was significantly associated with less severe BDI (p=0.018). This study stated that the type of previous cholecystectomy, timing of BDI diagnosis, and duration of BDI to repair procedures did not statistically influence mortality (p=0.822, p=0.551, p=0.958, respectively).
Conclusion: Prevention of BDI is paramount, emphasizing surgical training, careful patient selection, and the critical view of safety technique. Early detection, multidisciplinary management tailored to the injury’s severity improve outcomes. While minimally invasive approaches are preferred for minor BDIs, major injuries necessitate surgical intervention by experienced hepatobiliary surgeons.
Keywords
References
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DOI: 10.24871/2622025143-153
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