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Omar MA, Kamal A, Redwan AA, Alansary MN, Ahmed EA. Post-cholecystectomy major bile duct injury: ideal time to repair based on a multicentre randomized controlled trial with promising results. Int J Surg 2023; 109:1208-1221. [PMID: 37072143 PMCID: PMC10389623 DOI: 10.1097/js9.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Bile duct injury (BDI) is one of the serious complications of cholecystectomy procedures, which has a disastrous impact on long-term survival, health-related quality of life (QoL), healthcare costs as well as high rates of litigation. The standard treatment of major BDI is hepaticojejunostomy (HJ). Surgical outcomes depend on many factors, including the severity of the injury, the surgeons' experiences, the patient's condition, and the reconstruction time. The authors aimed to assess the impact of reconstruction time and abdominal sepsis control on the reconstruction success rate. METHODS This is a multicenter, multi-arm, parallel-group, randomized trial that included all consecutive patients treated with HJ for major post-cholecystectomy BDI from February 2014 to January 2022. Patients were randomized according to the time of reconstruction by HJ and abdominal sepsis control into group A (early reconstruction without sepsis control), group B (early reconstruction with sepsis control), and group C (delayed reconstruction). The primary outcome was successful reconstruction rate, while blood loss, HJ diameter, operative time, drainage amount, drain and stent duration, postoperative liver function tests, morbidity and mortality, number of admissions and interventions, hospital stay, total cost, and patient QoL were considered secondary outcomes. RESULTS Three hundred twenty one patients from three centres were randomized into three groups. Forty-four patients were excluded from the analysis, leaving 277 patients for intention to treat analysis. With univariate analysis, older age, male gender, laparoscopic cholecystectomy, conversion to open cholecystectomy, failure of intraoperative BDI recognition, Strasberg E4 classification, uncontrolled abdominal sepsis, secondary repair, end-to-side anastomosis, diameter of HJ (< 8 mm), non-stented anastomosis, and major complications were risk factors for successful reconstruction. With multivariate analysis, conversion to open cholecystectomy, uncontrolled sepsis, secondary repair, the small diameter of HJ, and non-stented anastomosis were the independent risk factors for the successful reconstruction. Also, group B patients showed decreased admission and intervention rates, decreased hospital stay, decreased total cost, and early improved patient QoL. CONCLUSION Early reconstruction after abdominal sepsis control can be done safely at any time with comparable results for delayed reconstruction in addition to decreased total cost and improved patient QoL.
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Affiliation(s)
| | - Ayman Kamal
- Anesthesia and Intensive Care, South Valley University, Qena
| | - Alaa A. Redwan
- Department of General Surgery, Helwan University, Helwan
| | | | - Emad Ali Ahmed
- Department of General Surgery, Helwan University, Helwan
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Postoperative liver function tests can predict anastomotic dysfunction after bile duct injury repair. Updates Surg 2022; 74:937-944. [PMID: 35415799 DOI: 10.1007/s13304-022-01275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/07/2022] [Indexed: 12/07/2022]
Abstract
Liver function tests help in the follow-up of postoperative patients with iatrogenic bile duct injury. There is not clear evidence regarding their predictive role on anastomosis dysfunction. We describe our experience with postoperative liver function tests and a predictive model of long-term patency after repair. This is retrospective cohort study of patients with bilioenteric anastomosis for bile duct injury and their long-term follow-up. A binomial logistic regression model was performed to ascertain the effects of the grade of bile duct injury and liver function test in the postoperative period. A total of 329 patients were considered for the analysis. In the logistic regression model two predictor variables were statistically significant for anastomosis stenosis: type of bilioenteric anastomosis and alkaline phosphatase levels. A ROC curve analysis was made for alkaline phosphatase with an area under the curve of 0.758 (95% CI 0.67-0.84). A threshold of 323 mg/dL was established (OR 6.0, 95% CI 2.60-13.83) with a sensitivity of 75%, specificity of 67%, PPV of 20%, NPV of 96%, PLR of 2.27 and NLR of 0.37. Increased alkaline phosphatase (above 323 mg/dL) after the fourth operative week was found to be a predictor of long-term dysfunction.
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Keyur B, Pankaj D, Dhaval M, Daxa K. Bile Duct Injury: Surgical Use of Endobiliary Stents for the Management in Emergency Situations. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury. J Am Coll Surg 2021; 233:213-222.e1. [PMID: 34111530 DOI: 10.1016/j.jamcollsurg.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bile duct injury sustained during laparoscopic cholecystectomy is associated with high morbidity and mortality, and can be a devastating complication for a general surgeon. We introduce a novel, individualized surgical coaching program for surgeons who recently injured a bile duct in laparoscopic cholecystectomy. We aim to explore the perception of coaching among these surgeons and to assess surgeons' experiences in the coaching program. STUDY DESIGN Six general surgeons who injured a bile duct at an emergency laparoscopic cholecystectomy participated in a 1-on-1 coaching session with a hepatopancreatobiliary surgeon. The session focused on debriefing the index case with video feedback, and discussion of strategies for safe laparoscopic cholecystectomy. The pilot program ran from March to November 2020. Exit interviews were then conducted. Themes covering perception of surgical training, perception of complications, and experience in the coaching program were explored. RESULTS Surgeons were generally accepting of the coaching program, especially when the goals aligned with their self-identified areas of development. One-on-1 sessions with a local expert in the area, and the use of video feedback created a unique and interactive coaching opportunity. Peer coaching was identified as a valuable resource in helping surgeons regain confidence and maintain well-being after a bile duct injury. Maintaining a collegial, nonjudgmental relationship is critical in establishing positive coaching experiences. CONCLUSIONS An individualized surgical coaching program creates a unique opportunity for professional development and may help promote safe laparoscopic cholecystectomy.
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Gad EH, Kamel Y, Salem TAH, Ali MAH, Sallam AN. Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study. ANNALS OF MEDICINE AND SURGERY (2012) 2021. [PMID: 33552489 DOI: 10.1016/j.amsu.2021.01.052.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kasai portoenterostomy(KPE) is the treatment of choice for the fatal devastating infantile type III biliary atresia (BA). The study aimed to analyze short-and long-term outcomes after this procedure and their predictors in a tertiary center. METHODS We retrospectively analyzed 410 infants who underwent KPE for type III BA in the period from February 2000 to December 2019. The overall male/female ratio was 186/224. RESULTS The early (>6months) complications involved 187(45.6%) of our infants with a higher incidence of early cholangitis that affected 108(26.3%) of them. The jaundice clearance at the 6th post-operative month that reached 138(33.7%) of them had an independent correlation with mild portal tracts ductal and/or ductular proliferation, using postoperative steroids therapy, and absence of early postoperative cholangitis. The early infant mortality that affected 70(17.1%) of our patients was mostly from sepsis. On the other hand, late (<6months) patients complications and mortalities affected 256(62.4%) and 240(58.5%) of patients respectively; moreover, liver failure and sepsis were the most frequent causes of late mortalities in non-transplanted and transplanted cases respectively. Lastly, the long-term (20-year) native liver survival (NLS) that reached 91(22.2%) of patients had an independent correlation with age at operation ≤ 90 days, higher preoperative mean serum alb, portal tract fibrosis grades F0 and F1, absence of intraoperative bleeding, absence of post-operative cholangitis, the occurrence of jaundice clearance at the 6th postoperative month and absence of post-operative portal hypertension (PHN). CONCLUSIONS Sepsis had a direct effect on early and late patient mortalities after Kasai operation for type III BA; moreover, patient age at operation<90 days, higher fibrosis grades, the occurrence of postoperative cholangitis and PHN, and persistence of post-operative jaundice had negative insult on long-term postoperative outcome. So, it is crucial to modulate these factors for a better outcome.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | | | | | - Ahmed Nabil Sallam
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
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Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study. Ann Med Surg (Lond) 2021; 62:302-314. [PMID: 33552489 PMCID: PMC7847812 DOI: 10.1016/j.amsu.2021.01.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
Kasai portoenterostomy(KPE) is the treatment of choice for the fatal devastating infantile type III biliary atresia (BA). The study aimed to analyze short-and long-term outcomes after this procedure and their predictors in a tertiary center. METHODS We retrospectively analyzed 410 infants who underwent KPE for type III BA in the period from February 2000 to December 2019. The overall male/female ratio was 186/224. RESULTS The early (>6months) complications involved 187(45.6%) of our infants with a higher incidence of early cholangitis that affected 108(26.3%) of them. The jaundice clearance at the 6th post-operative month that reached 138(33.7%) of them had an independent correlation with mild portal tracts ductal and/or ductular proliferation, using postoperative steroids therapy, and absence of early postoperative cholangitis. The early infant mortality that affected 70(17.1%) of our patients was mostly from sepsis. On the other hand, late (<6months) patients complications and mortalities affected 256(62.4%) and 240(58.5%) of patients respectively; moreover, liver failure and sepsis were the most frequent causes of late mortalities in non-transplanted and transplanted cases respectively. Lastly, the long-term (20-year) native liver survival (NLS) that reached 91(22.2%) of patients had an independent correlation with age at operation ≤ 90 days, higher preoperative mean serum alb, portal tract fibrosis grades F0 and F1, absence of intraoperative bleeding, absence of post-operative cholangitis, the occurrence of jaundice clearance at the 6th postoperative month and absence of post-operative portal hypertension (PHN). CONCLUSIONS Sepsis had a direct effect on early and late patient mortalities after Kasai operation for type III BA; moreover, patient age at operation<90 days, higher fibrosis grades, the occurrence of postoperative cholangitis and PHN, and persistence of post-operative jaundice had negative insult on long-term postoperative outcome. So, it is crucial to modulate these factors for a better outcome.
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Függer R. Challenging situations in cholecystectomy and strategies to overcome them. Eur Surg 2021. [DOI: 10.1007/s10353-020-00687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Summary
Background
Cholecystectomy may be difficult and hazardous, causing major morbidity and mortality. This review aims to identify situations increasing the probability of difficult gallbladders and present today’s best practice to overcome them.
Methods
Review of the literature and expert comment.
Results
One in six gallbladders is expected to be a difficult cholecystectomy. The majority can be predicted by patient history, clinical symptoms, and pre-existing comorbidities. Acute cholecystitis, mild biliary pancreatitis, prior endoscopic sphincterotomy, and liver cirrhosis are the predominant underlying diseases. Early or delayed cholecystectomy, percutaneous cholecystostomy, and pure conservative treatment are evidence-based options. Early laparoscopic cholecystectomy is of advantage in patients fit for surgery, with subtotal cholecystectomy or conversion to open surgery as bail-out strategies. The choice of the procedure depends on the experience of the surgeon.
Conclusion
Clinical decisions should follow a pathway based on patients’ risk, favoring laparoscopic cholecystectomy whenever possible. The implementation of an institutional pathway to deal with difficult gallbladders is recommended.
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Dai HS, Liang L, Zhang CC, Cheng ZJ, Peng YH, Zhang YM, Geng XP, Qin HJ, Wang K, Chen W, Yu C, Wang LF, Lau WY, Zhang LD, Zheng SG, Bie P, Shen F, Wu MC, Chen ZY, Yang T. Impact of iatrogenic biliary injury during laparoscopic cholecystectomy on surgeon's mental distress: a nationwide survey from China. HPB (Oxford) 2020; 22:1722-1731. [PMID: 32284280 DOI: 10.1016/j.hpb.2020.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/17/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Iatrogenic biliary injury (IBI) following laparoscopic cholecystectomy (LC) is the most serious iatrogenic complications. Little is known whether LC-IBI would lead to surgeon's severe mental distress (SMD). METHODS A cross-sectional survey in the form of electronic questionnaire was conducted among Chinese general surgeons who have caused LC-IBI. The six collected clinical features relating to mental distress included: 1) feeling burnout, anxiety, or depression, 2) avoiding performing LC, 3) having physical reactions when recalling the incidence, 4) having the urge to quit surgery, 5) taking psychiatric medications, and 6) seeking professional psychological counseling. Univariable and multivariable analyses were performed to identify risk factors of SMD, which was defined as meeting ≥3 of the above-mentioned clinical features. RESULTS Among 1466 surveyed surgeons, 1236 (84.3%) experienced mental distress following LC-IBI, and nearly half (49.7%, 614/1236) had SMD. Multivariable analyses demonstrated that surgeons from non-university affiliated hospitals (OR:1.873), patients who required multiple repair operations (OR:4.075), patients who required hepaticojejunostomy/partial hepatectomy (OR:1.859), existing lawsuit litigation (OR:10.491), existing violent doctor-patient conflicts (OR:4.995), needing surgeons' personal compensation (OR:2.531), and additional administrative punishment by hospitals (OR:2.324) were independent risk factors of surgeon's SMD. CONCLUSION Four out of five surgeons experienced mental distress following LC-IBI, and nearly half had SMD. Several independent risk factors of SMD were identified, which could help to make strategies to improve surgeons' mental well-being.
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Affiliation(s)
- Hai-Su Dai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lei Liang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Cheng-Cheng Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhang-Jun Cheng
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yong-Hai Peng
- Department of Hepatobiliary Surgery, Mianyang Center Hospital, Mianyang, China
| | - Yao-Ming Zhang
- The 2nd Department of Hepatobiliary Surgery, Meizhou People's Hospital (Huangtang Hosptial), Meizhou, China
| | - Xiao-Ping Geng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hong-Jun Qin
- Department of Hepatobiliary Surgery, Armed Police Crops Hospital of Sichuan Province, Sichuan, China
| | - Kai Wang
- Hepatobiliary and Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Chen
- Department of Hepatobiliary Surgery, The First People's Hospital of Zunyi, Zunyi, China
| | - Chao Yu
- Department of Hepatic-Biliary-Pancreatic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Li-Fei Wang
- Department of Mental Health Education, School of Marxism, Chongqing Jiaotong University, Chongqing, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai; Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR
| | - Lei-Da Zhang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shu-Guo Zheng
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping Bie
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Meng-Chao Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai.
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Díaz-Martínez J, Chapa-Azuela O, Roldan-García JA, Flores-Rangel GA. Bile duct injuries after cholecystectomy, analysis of constant risk. Ann Hepatobiliary Pancreat Surg 2020; 24:150-155. [PMID: 32457259 PMCID: PMC7271110 DOI: 10.14701/ahbps.2020.24.2.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 11/24/2022] Open
Abstract
Backgrounds/Aims The bile duct injuries are the most severe complications that occur after the surgical manipulation of the bile duct. The hepaticojejunostomy remained as the best treatment. Several factors identified that affect the result. This study aimed to analyze and identify risk factors that affected the evolution of these patients. Methods A retrospective, observational study was conducted from February 1998 to June 2017. We included all patients with bile duct injuries who required surgical treatment. Results We found 79 patients. The majority had a Bismuth type III in 35.4% (n=28). The morbidity of the Hepaticojejunostomy was 19% (n=15). In short-term follow-up, the main complications were cholangitis 11.4% (n=9) and bile leak 10% (n=8). In the long-term follow-up, in 2.5% (n=2) stricture was presented. On the comparison between postoperative and preoperative parameters, biliary peritonitis after a cholecystectomy (p=0.02) was an independent predictor of postoperative morbidity (p<0.05). Conclusions In the treatment of bile duct injuries, different factors affect their outcomes. Our results show that infectious complications continue to affect the results of the treatment of bile duct lesions.
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Affiliation(s)
- Jair Díaz-Martínez
- Hepato Pancreato Biliary Clinic, Hospital General de Mexico, Mexico City, Mexico
| | - Oscar Chapa-Azuela
- Hepato Pancreato Biliary Clinic, Hospital General de Mexico, Mexico City, Mexico
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Miyayama S, Yamashiro M, Sugimori N, Ikeda R, Ishida T, Sakuragawa N, Terada T. Intraoperative Bile Duct Disruption Treated Using Intrahepatic Biliary Ablation with Ethanol: A Report of Two Cases. INTERVENTIONAL RADIOLOGY 2020; 5:134-140. [PMID: 36284755 PMCID: PMC9550411 DOI: 10.22575/interventionalradiology.2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/30/2020] [Indexed: 11/23/2022]
Abstract
We report two cases of intraoperative bile duct disruption. In case 1, an isolated bile duct in the remnant of the anterosuperior liver segment after right hepatic lobectomy for cholangiocarcinoma caused bile leakage. In case 2, bile leakage continued from a disrupted accessory hepatic duct during pancreaticoduodenectomy for pancreatic carcinoma. In both patients, a mixture of ethanol and iodized oil at a 10:1 ratio was injected into the disrupted bile duct under balloon occlusion. In case 1, the mixture was injected through a balloon catheter under balloon occlusion overnight. No severe complications developed in either case. Bile leakage stopped postoperatively and did not recur until the patients' death from tumor progression 14 and 16 months after surgery, respectively.
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Affiliation(s)
- Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui
| | - Masashi Yamashiro
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui
| | - Natsuki Sugimori
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui
| | - Rie Ikeda
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui
| | - Takuya Ishida
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui
| | - Naoko Sakuragawa
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui
| | - Takuro Terada
- Department of Hepatobiliary-pancreatic surgery, Fukui-ken Saiseikai Hospital, Fukui
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Zhou SY, Shen HP, Zhang GL, Sun C. Impact of fast track surgery on inflammatory factors, gastrointestinal hormones, and gastrointestinal function in patients undergoing hepatobiliary surgery. Shijie Huaren Xiaohua Zazhi 2019; 27:305-310. [DOI: 10.11569/wcjd.v27.i5.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatobiliary surgery, due to complex physiological and anatomical structures, is difficult and risky, and patients often have a strong stress reaction, which will affect the smooth operation and postoperative rehabilitation. Fast track surgery can strengthen perioperative process management by using various effective measures confirmed by evidence-based medicine, and its application in hepatobiliary surgery is worthy of affirmation. However, there are few studies reporting inflammatory factors and gastrointestinal hormones in patients undergoing hepatobiliary surgery using a fast track surgery program.
AIM To study the effect of fast track surgery on inflammatory factors, gastrointestinal hormones, and gastrointestinal function in patients undergoing hepatobiliary surgery.
METHODS A total of 126 patients undergoing hepatobiliary surgery from May 2017 to April 2018 were divided into an intervention group and a control group. The control group was given conventional surgical management, and the intervention group given was given fast track surgery management. Serum inflammatory factors, gastrointestinal hormones, gastrointestinal function recovery time, and complications were compared between the two groups.
RESULTS Serum tumor necrosis factor-α, C reactive protein, and interleukin-6 were significantly lower in the intervention group than in the control group (36.20 pg/mL ± 5.32 pg/mL vs 43.55 pg/mL ± 6.12 pg/mL, 12.42 mg/L ± 2.35 mg/L vs 18.65 mg/L ± 3.24 mg/L, 10.24 pg/L ± 2.10 pg/L vs 15.04 pg/L ± 2.32 pg/L; t = 7.194, 12.355, 12.175; P < 0.05 or P < 0.01). Serum motilin and gastrin were significantly higher in the intervention group than in the control group (205.45 pg/mL ± 25.16 pg/mL vs 168.24 pg/mL ± 24.25 pg/mL, 124.32 pg/mL ± 24.15 pg/mL vs 104.36 pg/mL ± 20.42 pg/mL; t = 8.452, 5.009; P < 0.05, P < 0.01). Time to recovery of bowel sounds, time to anal exhaust, time to first defecation, and postoperative hospital stay were significantly shorter in the intervention group than in the control group [16.45 h ± 3.12 h vs 21.24 h ± 3.65 h, 20.34 h ± 4.54 h vs 41.25 h ± 6.12 h, 38.65 h ± 5.24 h vs 57.42 h ± 7.15 h, 9.21 d ± 1.32 d vs 13.54 d ± 2.12 d; t = 7.918, 21.780, 18.607, 13.762; P < 0.05 or P < 0.01). The rate of complications such as incision infection was significantly lower in the intervention group than in the control group (9.52% vs 26.98%, χ2 = 6.436, P < 0.05).
CONCLUSION Fast track surgery can promote gastrointestinal function recovery and reduce complications in patients undergoing hepatobiliary surgery, which may be related to inhibiting inflammatory response and regulating gastrointestinal hormones.
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Affiliation(s)
- Shi-Yu Zhou
- Department of General Surgery, Huzhou Central Hospital, Huzhou 313000, Zhejiang Province, China
| | - Hua-Ping Shen
- Department of General Surgery, Huzhou Central Hospital, Huzhou 313000, Zhejiang Province, China
| | - Guo-Lei Zhang
- Department of General Surgery, Huzhou Central Hospital, Huzhou 313000, Zhejiang Province, China
| | - Cheng Sun
- Department of General Surgery, Huzhou Central Hospital, Huzhou 313000, Zhejiang Province, China
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