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INCIDENCE AND IMPACT OF VASCULAR INJURY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY BILE DUCT INJURIES: A PROSPECTIVE OBSERVATIONAL STUDY
Utpal Anand
*, Rohith Kodali, Rajeev Nayan Priyadarshi
Surgical Gastroenterology, All India Institute of Medical Sciences - Patna, Patna, Bihar, India
Introduction: The impact of vascular injuries in the management of post-cholecystectomy bile duct injuries (BDI) has not been assessed in prospective studies. This study aimed to compare the clinical presentation and results of treatment of post-cholecystectomy bile duct injuries with and without arterial injuries.
Methods: A prospective analysis of 90 patients with post-cholecystectomy BDI presented between July 2018 to June 2021 was included. Multivariate logistic regression analysis was used to identify the impact of vascular injuries in perioperative complications following index surgery and the long-term outcome after delayed repair.
Results: Out of 90 patients, 34 (37.78%) had associated vascular injury with a majority of right hepatic artery disruption. Patients with associated vascular injuries had increased perioperative complications after the index surgery as compared to those with isolated BDI (Cholangiolar abscess- 89.29% vs 39.2% ( p<0.001), recurrent cholangitis- 75 % vs 58.82 % ( p=0.004), blood transfusions > 2- 85.19% vs 22.73% ( p<0.001), hospital admissions >3 days -88.2% vs 48.2% ( p<0.001), Clavien Dindo grade 3 14.29% vs 9.8% ( p-0.044). Delayed Hepp-Couinaud biliary repair was done in 79 patients (28 with vascular and 51 with isolated BDI). After 24 months of follow-up, 57(46.43% vs 86.2% ), 8 (25% vs 2%), 6 (14.29% vs 4%), and 8 (14.29% vs 8%) patients had excellent, good, fair, and poor outcomes according to McDonald's classification with no statistically significant difference in the outcome.
Conclusion: Concomitant vasculobiliary injuries were associated with increased morbidity after index surgery but the long-term outcomes following definitive biliary repair were the same.
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