RISK FACTORS FOR POST CHOLECYSTECTOMY VASCULOBILIARY INJURIES: A PROSPECTIVE STUDY IN IRAQI REFERRAL CENTER

Ali Dawood Al-Hilfi, Raafat R. Ahmed

Abstract


Abstract

Background: Vasculobiliary injuries (VBIs) during laparoscopic and open cholecystectomy are still  serious problems which may cause liver ischemia. Injuries occur as a result of technical errors or misidentification of biliary ducts. VBIs are major cause of patient morbidity and litigation.

Aim: This study represents an analytical review of the patients of vasculobiliary injuries with the aim of providing risk factors, causes, relative frequencies, the clinical implications of such injuries and how to prevent such disastrous vasculobiliary injuries.

Patients and Methods: This prospective clinical study conducted in the Department of Surgery in Gastroenterology and Hepatology Teaching Hospital in Medical City/Baghdad from 18th of December 2011 to 25th of December 2013 and completed the research in Washington University in Saint Louis from 7th of January 2014 to 8th of March 2014 with The Pioneer Hepato-Pancreato-Biliary surgeon in the world (Professor Steven M. Strasberg) under the scholarship research program of Iraqi Ministry of Higher Education and Scientific Research.  Fifty patients with VBIs were included in this prospective study ranging from 24 to 66 years old (mean age 40.76 year), 9 (18%) males and 41 (82%) females. All patients with VBIs referred from other hospitals in Baghdad and other Iraqi governorates. We classified the risk factors into three groups: General patient risk factors, local patient risk factors & surgeon factors. In all patients, the prospective diagnosis of VBIs were correctly made on history, clinical presentation, blood investigations, chest & abdominal x-rays, sonography, computed tomography scan (CT), magnetic resonance cholangiopancreatography (MRCP) and rarely doppler sonography.

Results: This study finds that VBIs done by inexperienced surgeons were observed in 20% (n=10), diploma Surgeon 20% (n=10), and injuries that occurred in cholecystectomy in acute phase 72% (n=36), private hospitals in 20% (n=10), comorbidities 14% (n=7), previous laparotomies 20% (n=10) are statistically significance if compared to control group done in Gastroenterology and Hepatology Teaching Hospital.

Conclusions: VBIs represent serious and challenging surgical complications and this study finds that acute cholecystitis, hospital type, experience and education level of surgeon are the most significant risk factors in selective set of logistic regression models.

 

Keywords: cholecystectomy, bile duct injury, vasculobiliary injury.


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