Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy

Nuzzo, Gennaro; Giuliante, Felice; Giovannini, Ivo; Murazio, Marino; D'Acapito, Fabrizio; Ardito, Francesco; Vellone, Maria; Gauzolino, Riccardo; Costamagna, Guido; Di Stasi, Carmine

doi:10.1016/j.amjsurg.2007.05.046

« Previous Next »The American Journal of Surgery
Volume 195, Issue 6 , Pages 763-769, June 2008

Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy

Gennaro Nuzzo, M.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
- Corresponding author. Tel.: +011-39 06 30154967; fax: +011-39 06 3058586.
Felice Giuliante, M.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Ivo Giovannini, M.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Marino Murazio, M.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Fabrizio D'Acapito, M.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Francesco Ardito, M.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Maria Vellone, M.D., Ph.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Riccardo Gauzolino, M.D.
- Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Guido Costamagna, M.D.
- Department of Surgery, Digestive Endoscopy Unit, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Carmine Di Stasi, M.D.
- Department of Radiology, Catholic University of the Sacred Heart School of Medicine, Rome, Italy

Received 26 May 2006; received in revised form 10 May 2007 published online 27 March 2008.

Abstract

Background

The aim of the present study was to highlight the advantages of treatment of bile duct injury (BDI) occurring during cholecystectomy on the basis of a multidisciplinary cooperation of expert surgeons, radiologists, and endoscopists.

Methods

Sixty-six patients had major BDIs or short- or long-term failures of repair. BDI was diagnosed intraoperatively in 27 patients (40.9%) and postoperatively in 39 (59.1%) patients. Among referred patients, 30 had complications from bile leak, 15 from obstructive jaundice, and 20 from recurrent cholangitis. Two patients died from sepsis after delayed referral before repair was attempted. Eleven additional patients had minor BDIs with bile leak both with and without choleperitoneum.

Results

Of patients with major BDI, surgical repair was performed in 41 (64.1%). Postsurgical morbidity rate was 15.8%, and there was no mortality. The rate of excellent or good results after surgical repair was 78.0% (32 of 41 patients), and this increased to 87.8% (36 of 41 patients) by continuing treatment with stenting in postsurgical strictures. Biliary stenting alone was performed in 23 patients (35.9%), with excellent or good results in 17 (73.9%). More than 200 endoscopic and percutaneous procedures were performed for initial assessment, treatment of sepsis, nonsurgical repair, contribution to repair, and follow-up. Patients with minor BDIs underwent various combinations of surgical and endoscopic or percutaneous treatments, always with good results.

Conclusions

A multidisciplinary approach was of paramount importance in many phases of treatment of BDI: initial assessment, treatment of secondary complications, resolution of sepsis, percutaneous stenting before surgical repair, dilatation of strictures after repair, final treatment in patients not repaired surgically, and follow-up.

Keywords: Bile duct injury, Laparoscopic cholecystectomy, Mortality, Multidisciplinary approach, Sepsis