Treatment of late identified iatrogenic injuries of the right and left hepatic duct after laparoscopic cholecystectomy without transhepatic stent and Witzel drainage: Case report

Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review

Background: Post-cholecystectomy bile duct injuries (BDIs) represent a challenging complication, with negative impacts on clinical outcomes. Several surgical and endoscopic/interventional radiologist (IR) approaches have been proposed to manage these damages, though with high failure rates. This individual patient data (IPD) systematic review analyzes the potential risk factors for failure after treatment interventions for BDIs, both surgical and endoscopic/IR. Methods: An extensive literature search was conducted on MEDLINE and Scopus for relevant articles published in English on the management of BDIs after cholecystectomy, between 1 January 2010 and 31 December 2023. Our series of BDIs was included. BDIs were always categorized according to the Strasberg's classification. The composite primary endpoints evaluated were the failure of treatment interventions, defined as patient death or the requirement of any other procedure, whatever surgical and/or endoscopic/IR, after the primary treatment. Results: A total of 342 cases were retrieved from our literature analysis, including our series of 19 patients. Among these, three groups were identified: "upfront surgery", "upfront endoscopy and/or IR" and "no upfront treatment", consisting of 224, 109 and 9 patients, respectively. After eliminating the third group, treatment intervention failure was observed overall in 34.2% (114/333) of patients, of whom 80.7% (92/114) and 19.3% (22/114) in the "upfront surgery" and in the "upfront endoscopy/IR" groups, respectively. At multivariable analysis, injury type D and E, and repair in a non-specialized center represented independent predictors of treatment failure in both groups, whereas laparoscopic cholecystectomy (LC) converted to open and immediate attempt of surgical repair exclusively in the first group. Conclusions: Significant treatment failure rates are responsible for remarkable negative effects on immediate and longer-term clinical outcomes of post-cholecystectomy BDIs. Understanding the important risk factors for this outcome may better guide the most appropriate therapeutical approach and improve clinical decisions in case this serious complication occurs.

Effect of implementation of operating room nursing path in patients receiving laparoscopic cholecystectomy in a tertiary hospital

BACKGROUND

Laparoscopic cholecystectomy (LC) has become a common procedure of biliary surgery, and the success of the operation is not only dependent on the skill of the surgeon, but also closely related to skilled nursing operations.

AIM

To observe the effect of application of the operating room nursing path in patients undergoing LC in a tertiary hospital.

METHODS

Sixty patients who underwent LC at our hospital from December 2016 to June 2019 were selected. According to the operation sequence, the patients were randomly divided into either a control group or an observation group. Both groups were given routine nursing care, and the operating room nursing path was additionally implemented in the observation group. Surgical parameters, postoperative recovery, complications, and potential safety problems were compared between the two groups.

RESULTS

In the observation group, operation time was 46.78 min ± 10.26 min, intraoperative blood loss was 35.36 mL ± 5.63 mL, time to gastrointestinal function recovery was 24.56 h ± 4.39 h, and hospitalization costs were $4573.28 ± $465.2, all of which were significantly lower than those of the control group (P < 0.01). The rate of complications was significantly lower in the observation group than in the control group (3.33% vs 16.67%, P < 0.05). The incidence of safety incidents in operating room was also significantly lower in the observation group than in the control group (0 vs 16.67%, P < 0.05).

CONCLUSION

The implementation of operating room nursing path can ensure the smooth progress of laparoscopic surgery, shorten the operation time, reduce postoperative complications, and decrease potential safety problems in operating room, thereby improving the quality of nursing services.