Publicaciones científicas
Textbook outcome in patients with biliary duct injury during cholecystectomy
Victor Lopez-Lopez 1 , Christoph Kuemmerli 2 , Javier Maupoey 3 , Rafael López-Andujar 3 , Laura Lladó 4 , Kristel Mils 4 , Philip Müller 5 , Andres Valdivieso 6 , Marina Garcés-Albir 7 , Luis Sabater 7 , Andrea Benedetti Cacciaguerra 8 , Marco Vivarelli 8 , Luis Díez Valladares 9 , Sergio Annese Pérez 10 , Benito Flores 10 , Roberto Brusadin 11 , Asunción López Conesa 11 , Sagrario Martinez Cortijo 12 , Sandra Paterna 13 , Alejando Serrablo 13 , Ferdinand Heinz Walther Toop 14 , Karl Oldhafer 14 , Santiago Sánchez-Cabús 15 , Antonio González Gil 16 , Jose Antonio González Masía 17 , Carmelo Loinaz 18 , Jose Luis Lucena 19 , Patricia Pastor 20 , Cristina Garcia-Zamora 21 , Alicia Calero 22 , Juan Valiente 23 , Antonio Minguillon 24 , Fernando Rotellar 25 , Cándido Alcazar 26 , Javier Aguilo 27 , Jose Cutillas 28 , Jose A Ruiperez-Valiente 29 , Pablo Ramírez 11 , Henrik Petrowsky 30 , Jose Manuel Ramia 26 , Ricardo Robles-Campos 11
Background: Iatrogenic bile duct injury (BDI) during cholecystectomy is associated with a complex and heterogeneous management owing to the burden of morbidity until their definitive treatment. This study aimed to define the textbook outcomes (TOs) after BDI with the purpose to indicate the ideal treatment and to improve it management.
Methods: We collected data from patients with an BDI between 1990 and 2022 from 27 hospitals. TO was defined as a successful conservative treatment of the iatrogenic BDI or only minor complications after BDI or patients in whom the first repair resolves the iatrogenic BDI without complications or with minor complications.
Results: We included 808 patients and a total of 394 patients (46.9%) achieved TO. Overall complications in TO and non-TO groups were 11.9% and 86%, respectively (P < .001). Major complications and mortality in the non-TO group were 57.4% and 9.2%, respectively. The use of end-to-end bile duct anastomosis repair was higher in the non-TO group (23.1 vs 7.8, P < .001). Factors associated with achieving a TO were injury in a specialized center (adjusted odds ratio [aOR], 4.01; 95% CI, 2.68-5.99; P < .001), transfer for a first repair (aOR, 5.72; 95% CI, 3.51-9.34; P < .001), conservative management (aOR, 5.00; 95% CI, 1.63-15.36; P = .005), or surgical management (aOR, 2.45; 95% CI, 1.50-4.00; P < .001).
Conclusion: TO largely depends on where the BDI is managed and the type of injury. It allows hepatobiliary centers to identify domains of improvement of perioperative management of patients with BDI.
CITA DEL ARTÍCULO J Gastrointest Surg. 2024 Feb 21:S1091-255X(24)00334-2. doi: 10.1016/j.gassur.2024.02.027
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