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Koppatz H, Sallinen V, Mäkisalo H, Nordin A. Outcomes and quality of life after major bile duct injury in long-term follow-up. Surg Endosc 2021; 35:2879-88. [PMID: 32572630 DOI: 10.1007/s00464-020-07726-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022]
Abstract
Introduction Recently new standards for reporting outcomes of bile duct injury (BDI) have been proposed. It is unclear how these treatment outcomes are reflected in quality of life (QOL). The aim of this study was to report outcomes and QOL after repair of major BDI and compare repairs by hepatobiliary surgeon to repairs by non-hepatobiliary surgeons. Methods This was a retrospective study of patients treated for major (Strasberg E-type) BDI after cholecystectomy at a tertiary hepatobiliary center. Outcomes were assessed using Cho-Strasberg proposed standards. QOL was assessed using Short Form Health Survey (SF-36) and the gastrointestinal QOL-index (GIQLI). Patients undergoing uneventful cholecystectomy matched by age, urgency, and duration of follow-up were used as controls. Results Fifty-two patients with major BDI treated between 2000 and 2016 were included (42% male, median age 53 years). Thirty-seven (71%) patients attained primary patency (29 (83%) if primarily operated by a hepatobiliary surgeon). Actuarial primary patency rate (grade A result) at 1, 3, and 5 years was 58%, 56%, and 53% in the whole cohort, and 83%, 80%, and 80% in patients primary treated by a hepatobiliary surgeon, respectively. At 3-year follow-up 6 (11.5%) patients obtained grade B, 10 (19.2%) grade C, and 7 (13.5%) grade D result. QOL was similar in patients with BDI and controls (median SF-36 physical component 51.7 and 53.6, p = 1.0, mental component 53.3 and 53.4, p = 1.0, GIQLI 109.0 and 123.0, p = 0.174, respectively) at median 90 (IQR 70–116) months from cholecystectomy. QOL was similar regardless of outcome grade. Conclusion First attempt to repair a severe BDI should be undertaken by a hepatobiliary surgeon. However, long-term QOL is not affected even by severe BDI, and QOL is not associated with the grade of the outcome.
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Halle-Smith JM, Hodson J, Stevens L, Mirza DF, Roberts KJ. Does non-operative management of iatrogenic bile duct injury result in impaired quality of life? A systematic review. Surgeon 2019; 18:113-121. [PMID: 31519430 DOI: 10.1016/j.surge.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/13/2019] [Accepted: 07/13/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Several studies have reported the effect of bile duct injury (BDI) on health-related quality of life (HRQOL) with conflicting results. This systematic review aims to study the impact of patient and treatment factors on HRQOL after BDI. METHODS A search of the PubMed database was performed and studies were reviewed as per the PRISMA guidelines. Selected studies (n = 11) were then divided into two subgroups depending on whether they found HRQOL to be similar or worse between BDI and control groups. Pooled rates of surgical repair and major BDI were calculated for each of these subgroups. RESULTS Surgical repair rates were 99% (95% CI: 96%-99%) in studies where the BDI patients had similar outcomes to controls, compared to 78% (40%-100%) where their outcomes were significantly worse (p = 0.091). The major BDI rate was 51% (95% CI: 42%-61%) in studies where the BDI patients had similar outcomes to controls, compared to 72% (41%-94%) where their outcomes were significantly worse (p = 0.322). Considerable heterogeneity was present within the two subgroups (I2: 68-99%). DISCUSSION HRQOL may be adversely affected amongst patients with BDI who do not undergo surgical repair. Significant heterogeneity of data suggests the need for standardised HRQOL tools and injury severity systems when assessing outcomes after BDI.
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Affiliation(s)
- James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham, Birmingham, United Kingdom
| | - James Hodson
- Medical Statistics, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Lewis Stevens
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Darius F Mirza
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham, Birmingham, United Kingdom.
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Cho JY, Baron TH, Carr-Locke DL, Chapman WC, Costamagna G, de Santibanes E, Dominguez Rosado I, Garden OJ, Gouma D, Lillemoe KD, Angel Mercado M, Mullady DK, Padbury R, Picus D, Pitt HA, Sherman S, Shlansky-Goldberg R, Tornqvist B, Strasberg SM. Proposed standards for reporting outcomes of treating biliary injuries. HPB (Oxford) 2018; 20:370-378. [PMID: 29397335 DOI: 10.1016/j.hpb.2017.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/06/2017] [Accepted: 10/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is no standard nor widely accepted way of reporting outcomes of treatment of biliary injuries. This hinders comparison of results among approaches and among centers. This paper presents a proposal to standardize terminology and reporting of results of treating biliary injuries. METHODS The proposal was developed by an international group of surgeons, biliary endoscopists and interventional radiologists. The method is based on the concept of "patency" and is similar to the approach used to create reporting standards for arteriovenous hemodialysis access. RESULTS The group considered definitions and gradings under the following headings: Definition of Patency, Definition of Index Treatment Periods, Grading of Severity of Biliary Injury, Grading of Patency, Metrics, Comparison of Surgical to Non Surgical Treatments and Presentation of Case Series. CONCLUSIONS A standard procedure for reporting outcomes of treating biliary injuries has been produced. It is applicable to presenting results of treatment by surgery, endoscopy, and interventional radiology.
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Affiliation(s)
- Jai Young Cho
- Department of Surgery, Seoul National University, Bundang Hospital, Seoul National University College of Medicine, Seongnam, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Republic of Korea
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 130 Mason Farm Road CB 7080, Chapel Hill, NC 27599, USA
| | - David L Carr-Locke
- The Center for Advanced Digestive Care, Weill Cornell Medicine, New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
| | - William C Chapman
- Section of Transplantation, Department of Surgery, Washington University in St Louis, 1 Barnes Hospital Plaza, St Louis, MO 63110, USA
| | - Guido Costamagna
- Digestive Endoscopy Unit, Catholic University of the Sacred Heart, Gemelli Hospital, Largo Agostino Gemelli, 8, Roma, RM 00168, Italy
| | - Eduardo de Santibanes
- Department of Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH CABA, Buenos Aires, Argentina
| | - Ismael Dominguez Rosado
- Department of Surgery, National Institute of Medical Sciences and Nutrition, Vasco de Quiroga 15 Col. Seccion XVI, Tlalpan C.P. 14000, Mexico City, Mexico
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Dirk Gouma
- Department of Surgery, Faculty of Medicine AMC, University of Amsterdam, Sweelincklaan 15, 1217 CK, Hilversum, The Netherlands
| | - Keith D Lillemoe
- Department of Surgery, White 506, 55 Fruit Street, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Miguel Angel Mercado
- Department of Surgery, National Institute of Medical Sciences and Nutrition, Vasco de Quiroga 15 Col. Seccion XVI, Tlalpan C.P. 14000, Mexico City, Mexico
| | - Daniel K Mullady
- Washington University in St Louis, Department of Medicine, Division of Gastroenterology, Campus Box 8124 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Flinders Dr, Bedford Park SA 5042, Australia
| | - Daniel Picus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd, St Louis, MO 63110, USA
| | - Henry A Pitt
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3509 N. Broad Street, Boyer Pavilion, E 938, Philadelphia, PA 19140, USA
| | - Stuart Sherman
- Department of Medicine, Division of Digestive and Liver Disorders, Indiana University Health-University Hospital, 550 North University Blvd, Suite 1634, Indianapolis, IN 46202, USA
| | - Richard Shlansky-Goldberg
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Silverstein 1st floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Bjorn Tornqvist
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Steven M Strasberg
- Section of HPB Surgery, Washington University in St Louis, 1 Barnes Hospital Plaza, St Louis, MO 63110, USA.
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Ejaz A, Spolverato G, Kim Y, Dodson R, Sicklick JK, Pitt HA, Lillemoe KD, Cameron JL, Pawlik TM. Long-term health-related quality of life after iatrogenic bile duct injury repair. J Am Coll Surg 2014; 219:923-32.e10. [PMID: 25127511 DOI: 10.1016/j.jamcollsurg.2014.04.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/27/2014] [Accepted: 04/30/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Data on the effect of bile duct injuries (BDI) on health-related quality of life (HRQOL) are not well defined. We sought to assess long-term HRQOL after BDI repair in a large cohort of patients spanning a 23-year period. STUDY DESIGN We identified and mailed HRQOL questionnaires to all patients treated for major BDI after laparoscopic cholecystectomy between January 1, 1990 and December 31, 2012 at Johns Hopkins Hospital. RESULTS We identified 167 patients alive at the time of the study who met the inclusion criteria. Median age at BDI was 42 years (interquartile range 31 to 54 years); the majority of patients were female (n = 131 [78.4%]) and of white race (n = 137 [83.0%]). Most patients had Bismuth level 2 (n = 56 [33.7%]) or Bismuth level 3 (n = 40 [24.1%]) BDI. Surgical repair most commonly involved a Roux-en-Y hepaticojejunostomy (n = 142 [86.1%]). Sixty-two patients (37.1%) responded to the HRQOL questionnaire. Median follow-up was 169 months (interquartile range 125 to 222 months). At the time of BDI, mental health was most affected, with patients commonly reporting a depressed mood (49.2%) or low energy level (40.0%). These symptoms improved significantly after definitive repair (both p < 0.05). Limitations in physical activity and general health remained unchanged before and after surgical repair (both p > 0.05). CONCLUSIONS Mental health concerns were more commonplace vs physical or general health issues among patients with BDI followed long term. Optimal multidisciplinary management of BDI can help restore HRQOL to preinjury levels.
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Affiliation(s)
- Aslam Ejaz
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Department of Surgery, University of Illinois Hospital and Health Sciences Center, Chicago, IL
| | - Gaya Spolverato
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Yuhree Kim
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Rebecca Dodson
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Jason K Sicklick
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA
| | - Henry A Pitt
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA
| | - Keith D Lillemoe
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John L Cameron
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
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Daskalaki D, Fernandes E, Wang X, Bianco FM, Elli EF, Ayloo S, Masrur M, Milone L, Giulianotti PC. Indocyanine green (ICG) fluorescent cholangiography during robotic cholecystectomy: results of 184 consecutive cases in a single institution. Surg Innov 2014; 21:615-21. [PMID: 24616013 DOI: 10.1177/1553350614524839] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIM Laparoscopic cholecystectomy is currently the gold standard treatment for gallstone disease. Bile duct injury is a rare and severe complication of this procedure, with a reported incidence of 0.4% to 0.8% and is mostly a result of misperception and misinterpretation of the biliary anatomy. Robotic cholecystectomy has proven to be a safe and feasible approach. One of the latest innovations in minimally invasive technology is fluorescent imaging using indocyanine green (ICG). The aim of this study is to evaluate the efficacy of ICG and the Da Vinci Fluorescence Imaging Vision System in real-time visualization of the biliary anatomy. METHODS A total of 184 robotic cholecystectomies with ICG fluorescence cholangiography were performed between July 2011 and February 2013. All patients received a dose of 2.5 mg of ICG 45 minutes prior to the beginning of the surgical procedure. The procedures were multiport or single port depending on the case. RESULTS No conversions to open or laparoscopic surgery occurred in this series. The overall postoperative complication rate was 3.2%. No biliary injuries occurred. ICG fluorescence allowed visualization of at least 1 biliary structure in 99% of cases. The cystic duct, the common bile duct, and the common hepatic duct were successfully visualized with ICG in 97.8%, 96.1%, and 94% of cases, respectively. CONCLUSIONS ICG fluorescent cholangiography during robotic cholecystectomy is a safe and effective procedure that helps real-time visualization of the biliary tree anatomy.
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Affiliation(s)
- Despoina Daskalaki
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Eduardo Fernandes
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Xiaoying Wang
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | | | | | - Subashini Ayloo
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Mario Masrur
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Luca Milone
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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