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Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama
Victor Lopez-Lopez1, Christoph Kuemmerli2, Jose Cutillas3
1Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain.
Insights
Vascular injuries during cholecystectomy are complex, especially in non-specialized centers. Referral to specialized centers for complex hepatobiliary surgery is crucial for optimal management and outcomes.
Area of Science:
- Hepatobiliary Surgery
- Vascular Surgery
- Surgical Complications
Background:
- Vascular injuries during cholecystectomy present significant management challenges.
- These complications are particularly difficult in centers lacking specialized hepatobiliary surgical expertise.
Purpose of the Study:
- To analyze the management strategies for vascular injuries occurring during cholecystectomy.
- To evaluate the impact of referral, repair timing, and treatment outcomes on patient management.
Main Methods:
- Multi-institutional retrospective study involving 104 patients across 18 centers in 4 countries.
- Data collected on vascular and biliary injuries during cholecystectomy, focusing on referral patterns and treatment interventions.
Main Results:
- Most vascular and biliary injuries (80.4%) occurred in non-specialized centers, with 53.6% requiring immediate transfer.
- Patients managed at the original hospital had higher reoperation rates (64% vs. 20%).
- Vascular reconstruction was linked to increased mortality (P=0.04), and two of four transplanted patients died.
Conclusions:
- Vascular lesions during cholecystectomy are life-threatening and necessitate mandatory referral to specialized centers.
- Prompt multidisciplinary care is essential for managing these complex injuries.
- Delayed vascular repair did not appear to be associated with poorer outcomes.
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.
