Iatrogenic common bile duct injuries: Increasing complexity in the laparoscopic era: A prospective cohort study

PURPOSE

Iatrogenic bile duct injury (BDI) is the most significant associated complication to laparoscopic cholecystectomy (LC). Little is known about the evolution of the pattern of BDI in the era of laparoscopy. The aim of the study is to assess the pattern of post-LC BDIs managed in a tertiary referral centre.

METHODS

Post-LC BDI referred over two decades were studied. Demographic data, type of BDI (classified using the Strasberg System), clinical symptoms, diagnostic investigations, timing of referral, post-referral management and morbidity were analysed. The pattern of injury, associated vascular injuries rate and their management were compared over two time periods (1992-2004,2005-2014).

RESULTS

78 BDIs were referred. During the second time period Strasberg A injuries decreased from 14% to 0 and Strasberg E1increased from 4% to 23%, the rate of associated vascular injury was six time higher (3.6% versus 22.7%), more patients had an attempted repair at the index hospital (16% versus 35%) sand fewer patients could be managed without surgical intervention at the referral hospital (28% versus 4%).

CONCLUSION

Complexity of referred BDIs and rate of associated vascular injuries have increased over time. These findings led to more patients managed requiring surgical intervention at the referral hospital.

Splinting proximal interphalangeal joint flexion contractures: a new design

Proximal interphalangeal joint flexion contracture is a common and persistent problem in hand rehabilitation. This article discusses the advantages and disadvantages of several current splint designs for correcting this contracture and introduces an alternate design that uses wire in a 3-point pressure system. The advantages of this design include ease of fabrication, patient appeal, and effectiveness.

Flexor tendon injuries. Treatment of the acute problem

The management of flexor tendon injuries continues to evolve as our knowledge of tendon biology and physiology improves. The concept of early motion after tendon repair is a key part of this evolutionary process. This section has provided a brief review of the history of early motion and presented a postoperative therapy program for flexor tendon repairs. Patient education, splinting (protective and corrective) and an exercise and activity program have been stressed. It must be emphasized that if early motion is used postoperatively, it must be done in conjunction with a closely supervised hand therapy program.