Post Cholecystectomy Bile Duct Injury in an Acute Setting: Categorization, Triaging, and Management Algorithm

Area of Science:

• Hepatobiliary surgery
• Surgical complications
• Gastroenterology

Background:

• Postcholecystectomy bile duct injury (BDI) presents significant management challenges, impacting patient morbidity, mortality, and long-term quality of life.
• Prompt referral to specialized hepatobiliary centers and effective early management are critical for optimizing outcomes in BDI cases.

Purpose of the Study:

• To retrospectively analyze patients managed for acute bile duct injury (BDI) over a decade.
• To propose and validate a triage and management algorithm for acute BDI settings to improve patient outcomes.

Main Methods:

• Retrospective review of 128 patients with acute BDI referred to a specialized center between 2011 and 2020.
• Patients were triaged based on bile leak presence and categorized into 'red', 'yellow', or 'green' zones according to sepsis, organ failure, and injury severity.
• Initial management focused on sepsis control, resuscitation, and organ support, followed by interventions guided by the proposed algorithm.

Main Results:

• 116 patients had BDI with bile leaks; 106 (91.38%) required invasive interventions (PCD insertion or laparotomy) due to sepsis or organ failure.
• 12 patients without bile leaks included 9 (75%) with cholangitis requiring interventions like PTBD or antibiotics.
• Three mortalities (2.34%) occurred, all in the severe 'red zone'; early repair was possible in only 5 patients acutely.

Conclusions:

• The developed categorization and management algorithm effectively stratifies BDI severity in acute settings.
• This approach simplifies complex cases, expedites decision-making, and demonstrably enhances patient outcomes following bile duct injury.