Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy ?
April 11, 2010
| Abstract Title: | Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy ? |
| Authors: | Kolozsvari Maria, Silindean Laura, Hoara Vlad |
| Affiliation: | “Vasile Goldis” Western University Arad, Romania Clinical Emergency Hospital, Department Of Surgery, Arad, Romania University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania |
| Abstract text: | Background. Bile duct injuries (BDI) have been reported to occur more frequently during laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC). Several studies have demonstrated various potential predisposing factors for BDI. However, there is a controversy as to whether gallbladder inflammation is a significant predictor for BDI. Therefore, out primary aim was to investigate the relationship between inflammation and BDI at LC, and secondarily to present the management and clinical outcome of BDI. Methods. We recorded all consecutive LC performed between 1998 and 2009 in our department by ten surgeons in the Surgical Department of Clinical Emergency Hospital Arad. BDI were classified according to Strasberg’s classification. Simple and multivariate logistic regression analysis was performed to evaluate the association between inflammation and BDI occurrence during LC. Results. There were 1498 patients. Among those, 270 present inflammation (18%). The conversion rate was 5% and was higher among male, elder patients, and those with inflammation. The BDI incidence was 0,96% (0,14% for major and 0,55% for minor injuries) and it was significantly higher in those with inflammation compared to those without inflammation (p=0,01). In particular the risc for BDI was almost 3,5 times higher in those with inflammation. Inflammation remained an independent risk factor for BDI even after adjustment for potential confounders. Among patients sustaining injury, two died and four have recurrent cholangitis. No association was observed between clinical outcome and management of BDI, time of diagnosis, sex, and inflammation. Conclusion. The study revealed that inflammation is an independent predictor of bile duct injuries occurrence during cholecystectomy. In this case, it would be advisable for surgeons not to hesitate in converting a laparoscopic cholecystectomy to an open cholecystectomy in the presence of inflammation. |
| Keywords: | cholecystectomy, common bile duct (CBD), complications |
| Presentation type: | Oral |
| Correspondence: | Clinical Emergency Hospital Arad, no. 1-3 Spitalului St. |
| Email: | vlad_hoara@yahoo.com |
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