Transition from a low- to a high-volume centre for bile duct repair: changes in technique and improved outcome
| Autor: | Rigoberto Arámburo-García, Artemio García, Bernardo Franssen, Miguel Angel Mercado, Fernando Ramirez-Del Val, Alejandro Elnecavé-Olaiz, Juan Carlos Arriola-Cabrera, Ismael Domínguez |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Time Factors medicine.medical_treatment Iatrogenic Disease Jejunostomy cholecystectomy Referral and Consultation Aged 80 and over gall bladder Bile duct Gastroenterology Middle Aged Hospitals Biliary Tract Surgical Procedures medicine.anatomical_structure Outcome and Process Assessment Health Care Treatment Outcome Female Stents Clinical Competence Learning Curve biliary Adult Reoperation medicine.medical_specialty Referral Adolescent bile duct injury Young Adult medicine Hepatectomy Humans Temporal change Mexico Aged Retrospective Studies Hepatology business.industry General surgery Retrospective cohort study Anastomosis Roux-en-Y Original Articles Surgery Wounds and Injuries Cholecystectomy Bile Ducts business |
| Zdroj: | HPB. 13(11):767-773 |
| ISSN: | 1365-182X |
| DOI: | 10.1111/j.1477-2574.2011.00356.x |
| Popis: | BackgroundImprovements in bile duct injury repairs have been shown in centres with specialized surgeons. The aim of the present study was to demonstrate the temporal change in the pattern of referral, technical variation associated with repair and long-term outcome of bile duct injuries at a tertiary referral centre in Mexico City.MethodsA retrospective case note review was performed. Patients were divided into two groups: group I (GI) 1990 to 2004 and group II (GII) 2005–2008, and appropriate statistical analysis undertaken.ResultsOver a 20-year period, 312 patients with iatrogenic bile duct injuries required surgical treatment (GI=169, GII=140 patients). All injuries were reconstructed using a Roux-en-Y hepaticojejunostomy. The proportion of patients who had undergone a laparoscopic cholecystectomy increased from 24% to 36% (P=0.017) over the two time periods. In the second time period there was an increase in segment IV and V partial resections (P=0.020), a reduction in the use of transanastomotic stents (42% to 2%, P=0.001) and an increase in the proportion of patients requiring a neoconfluence (2% to 11%, P=0.003). In the second time period, the number of patients requiring a hepatectomy during repair (2% to 1%, P=0.001), a portoenterostomy (16% to 9%, P=0.060) or a double-barrel hepatico-jejunostomy (5% to 1%, P=0.045) significantly decreased. During follow-up, patients in the second time period had a reduction in the incidence of post-operative cholangitis (11% to 6%, P=0.310) and the frequency of post-operative anastomotic stenoses (13% to 5%, P=0.010). Mortality remained low throughout the series but was absent in the second group.ConclusionsChanges in technique and growing experience of the multidisciplinary team improved operative and long-term results of bile duct injury repair. |
| Databáze: | OpenAIRE |
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