Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature

Laparoscopic cholecystectomy (LC) is the gold standard for treating gallstones; however, it is not free of complications. Postcholecystectomy duodenal injuries are rare but challenging complications after cholecystectomy. The objective of this study was to analyze the management of postcholecystectomy duodenal injuries and to review the related literature.

An observational and retrospective study was conducted. We included all patients with postcholecystectomy duodenal injuries treated at a reference center, from January 2019 to December 2023. In addition, a review of the literature was carried out.

Fifteen patients were found, mostly women; with gallbladder wall thickening on ultrasound (mean of 8 mm). The majority were emergency (n = 12, 80%) and LCs (n = 8, 53.33%). Cholecystectomies were reported to be associated with excessive difficulty (n = 10, 66.66%). The most injured duodenal portion was the first portion (n = 9, 60%), and blunt dissection was the most common mechanism of injury (n = 7, 46.66%). Most of these injuries were detected in the operating room (n = 9, 60%), and treated with primary closure (n = 11, 73.33%). Three patients with delayed injuries died (20%). According to the literature reviewed, 93 duodenal injuries were found, mostly detected intraoperatively, in the second portion, and treated with primary closure. A minority of patients were treated with more complex procedures, for a mortality rate of 15.38%.

Postcholecystectomy duodenal injuries are rare. Most of these injuries are detected and repaired intraoperatively. However, a high percentage of patients have high morbidity and mortality.

Diaz-Martinez J, Pérez-Correa N. Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature. Euroasian J Hepato-Gastroenterol 2024;14(1):44-50.