Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama

Autor: Victor Lopez-Lopez, Christoph Kuemmerli, Jose Cutillas, Javier Maupoey, Rafael López-Andujar, Emilio Ramos, Kristel Mils, Andres Valdivieso, Arkaitz Perfecto Valero, Pedro Antonio Martinez, Sandra Paterna, Alejando Serrablo, Tim Reese, Karl Oldhafer, Roberto Brusadin, Asunción López Conesa, Luis Díez Valladares, Carmelo Loinaz, Marina Garcés-Albir, Luis Sabater, Federico Mocchegiani, Marco Vivarelli, Sergio Annese Pérez, Benito Flores, Jose Luis Lucena, Santiago Sánchez-Cabús, Alicia Calero, Antonio Minguillon, Jose Manuel Ramia, Cándido Alcazar, Javier Aguilo, Jose A. Ruiperez-Valiente, Lukasz Filip Grochola, Pierre-Alain Clavien, Henrik Petrowsky, Ricardo Robles-Campos
Rok vydání: 2022
Předmět:
Zdroj: SURGERY
r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname
r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
Surgery
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
ISSN: 1532-7361
0039-6060
Popis: BACKGROUND: The management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery.; METHODS: This was a multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes.; RESULTS: A total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P= .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P ? .001). The need for vascular reconstruction was associated with higher mortality (P= .04). Two of the 4 patients transplanted died.; CONCLUSION: Vascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results. Copyright © 2022 Elsevier Inc. All rights reserved.
Databáze: OpenAIRE
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