[Bile duct injuries following cholecystectomy: current situation in the Russian Federation]

O assess the current situation regarding iatrogenic bile duct injuries (BDI) in the Russian Federation.

A retrospective analysis enrolled cases of BDI that required reconstructive surgery in 2023. Data were collected through online survey of medical institutions registered in annual reporting database of the Chief Surgeon of the Russian Ministry of Health, where BDIs were documented.

There were 227 BDIs. Data from 126 (59.0%) patients were obtained via online survey. Laparoscopic cholecystectomy (LC) was performed in 107 (84.9%) cases. Acute cholecystitis was indication in 77 (61.1%) cases. BDI occurred in 25 (19.8%) cases at the first level hospitals, 69 (54.8%) cases - at the second level, 32 (25.4%) cases - at the third level facilities. Intraoperative diagnosis of BDI was established in 62 (49.2%) cases. According to the Strasberg classification, type D injuries accounted for 32 cases, type E - 94 cases. Roux-en-Y hepaticojejunostomy was performed in 72 (57.1%) cases, bilio-biliary anastomosis over a T-tube - 20 (15.9%), bile duct repair over a stent - 8 (6.3%), primary bile duct suture without stent - 9 (7.1%), hemihepatectomy - 1 (0.8%), external biliary drainage - 12 (9.5%), other procedures - 4 (3.2%). Surgical approach and outcomes depended on timing of BDI diagnosis and type of intervention. Complications were observed in 20 (15.9%) cases, including hepaticojejunal anastomotic failure in 10/72 patients (13.9%). Overall mortality rate was 4.8%. The reported leading cause of BDI (83.3% of respondents) was difficult bile duct identification due to fibrotic-inflammatory changes in subhepatic space.

The main cause of BDI during cholecystectomy is fibrotic-inflammatory changes in subhepatic space. Compliance with principles of safe cholecystectomy is of paramount importance. BDI requires referral to a specialized center. Timely diagnosis of BDI improves the outcomes.