Surgical injury of the bile ducts in residents. Experience of a university training center

Abstract

Bile duct surgical injury (LQVB) is a dangerous complication of cholecystectomy, with significant postoperative sequelae. These have an estimated laparoscopic incidence of 0.4% to 1.5%. The aim of this study was to evaluate the incidence of LQVB during the training of the surgeon and the impact on morbidity and mortality with respect to the moment of its diagnosis.

A retrospective observational study of cholecystectomies was conducted by surgeons in training during January 2019 to March 2023. 

420 cholecystectomies were analyzed.  We recorded three cases of biliary tract surgical lesion (0.71%), where the diagnosis by intraoperative cholangiography (IOC) was in two cases and these patients in 3-year follow-up develop daily life. Presenting a mortality of 33.3% and this case was performed late detection of the injury. 

Other autors have reported that patients with LQVB have a significantly lower overall 1-year survival than patients without lesions and patients with late-detection lesions have almost twice the risk of mortality compared to patients with had no injuries. Others, however, did not observe differences in 1-year survival rates in patients with intraoperative LQVB compared to those without LQVB. There are certain tools for reducing LQVB rates, such as CIO, critical safety vision, and subtotal cholecystectomy. The CIO allows us to recognize the biliary anatomy, detect an injury and often reduce the degree of it. In case of intraoperative detection, it allows the possibility to resolve the lesion in a surgical time, or to call a surgeon with more experience, or in cases of not having the hospital structure for the perioperative management of major abdominal surgery, allows to place drains and refer to a reference center. LQVB is a serious complication. In many cases, it is difficult to avoid this complication, but early detection is essential. This is why the systematization of the CIO during surgeon training is irreplaceable.