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Disparities in bile duct injury care

  • Alexandra Rueda-De-Leon
  • Ismael Dominguez-RosadoEmail author
  • Alan G. Contreras
  • Mario Vilatoba
  • Miguel A. Mercado
Article

Abstract

Background

An international group proposed a standardized terminology to report outcomes after bile duct repair. Data on this surgical complication vary depending on the center and country where patients are treated. The aim of this work is to show disparities in the care process of bile duct injury between patients from two different income-level countries, using a standard terminology of outcomes and clinical reporting.

Methods

A retrospective review comparing primary repair and re-repaired cases performed in an upper middle-income country (UMIC) versus primary repair cases treated in a high-income country (HIC) was performed. All pertinent data included in the tabular reporting system and outcomes classification were collected. Patients’ characteristics were reported by calculating descriptive statistics.

Results

A total of 261 patients from UMIC (148 (56%) primary repair and 113 (44%) re-repair) were compared with 122 primary repair from HIC. Open cholecystectomy (55.4% vs 3.3%) and more E4 injuries (37.8% vs 19.7%) were found in the UMIC group. More Accordion 3 and higher complications were present in the UMIC primary and repair groups, as well as more episodes of postoperative acute cholangitis. Eleven patients were listed for liver transplant in the UMIC re-repair group. Primary patency by the end of the index treatment period was present in 217 (83%) of the full UMIC cohort. Median time to loss of primary patency was not reached in the primary repair, and was 3.8 years in the re-repair group. Patency was below HIC primary repaired cases.

Conclusions

Standardized reporting outcomes after primary repair are applicable to re-repaired patients and are helpful to compare different populations, showing better outcomes in HIC. Measures of surgical access disparities exist among the process of bile duct injury care.

Keywords

Bile duct Patency Primary repair Re-repair 

Notes

Compliance with ethical standards

Disclosures

Drs. Alexandra Rueda De Leon, Ismael Domínguez-Rosado, Alan G Contreras, Mario Vilatoba, and Miguel A Mercado have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Pitt H, Sherman S, Johnson MS, Hollenbeck AN, Lee J, Daum MR, Lillemoe KD, Lehman GA (2013) Improved outcomes of bile duct injuries in the 21st century. Ann Surg 258(3):490–499CrossRefGoogle Scholar
  2. 2.
    Walsh RM, Henderson JM, Vogt DP, Brown N (2007) Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery. 142(4):450–457CrossRefGoogle Scholar
  3. 3.
    Landman MP, Feurer ID, Moore DE, Zaydfudim V, Pinson CW (2013) The long-term effect of bile duct injuries on health-related quality of life: a meta-analysis. HPB (Oxford). 15(4):252–259CrossRefGoogle Scholar
  4. 4.
    Cho JY, Jaeger AR, Sanford DE, Fields RC, Strasberg SM (2015) Proposal for standardized tabular reporting of observational surgical studies illustrated in a study on primary repair of bile duct injuries. J Am Coll Surg 221(3):678–688CrossRefGoogle Scholar
  5. 5.
    Cho JY, Baron TH, Carr-locke DL, Chapman WC, Costamagna G, de Santibanes E, Dominguez Rosado I, Garden OJ, Gouma D, Lillemoe KD, Mercado MA, Mullade DK, Padbury R, Picus D, Pitt HA, Sherman S, Shlansky-Goldberg R, Tornqvist B, Strasberg SM (2018) Proposed standards for reporting outcomes of treating biliary injuries. HPB (Oxford) 20:370–378CrossRefGoogle Scholar
  6. 6.
    Dominguez-Rosado I, Sanford DE, Liu J, Hawkins WG, Mercado MA (2016) Timing of surgical repair after bile duct injury impacts postoperative complications but not anastomotic patency. Ann Surg 264(3):544–553CrossRefGoogle Scholar
  7. 7.
    Mercado MA, Franssen B, Dominguez I, Arriola-Cabrera JC, Ramírez-Del Val F, Elnecavé-Olaiz A, Aramburo-Garcia R, Garcia A (2011) Transition from a low to a high-volume centre for bile duct repair: changes in technique and improved outcome. HPB (Oxford) 13(11):767–773CrossRefGoogle Scholar
  8. 8.
    Data for Upper middle income, Mexico. The World Bank. https://data.worldbank.org/income-level/upper-middle-income. Accessed 03 Jan 2019
  9. 9.
    Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau KH, Miura F, Horiguchi A, Liu KH, Su CH, Wada K, Jagannath P, Itoi T, Gouma DJ, Mori Y, Mukai S, Giménez ME, Huang WS, Kim MH, Okamoto K, Belli G, Dervenis C, Chan ACW, Lau WY, Endo I, Gomi H, Yoshida M, Mayumi T, Baron TH, de Santibañes E, Teoh AYB, Hwang TL, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Higuchi R, Kitano S, Inomata M, Deziel DJ, Jonas E, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo guidelines 2018: diagnostic criteria and severity grading of acute Cholangitis (with videos). J Hepatobiliary Pancreat Sci. 25(1):17–30CrossRefGoogle Scholar
  10. 10.
    Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250(2):177–186CrossRefGoogle Scholar
  11. 11.
    de Reuver PR, Grossmann I, Busch OR, Obertop H, van Gulik TM, Gouma DJ (2007) Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury. Ann Surg 245(5):763–770CrossRefGoogle Scholar
  12. 12.
    Perera MT, Silva MA, Hegab B, Muralidharan V, Bramhall SR, Mayer AD, Buckels JA, Mirza DF (2011) Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injuries is associated with an improved long-term outcome. Ann Surg 253(3):553–560CrossRefGoogle Scholar
  13. 13.
    Cuendis-Velázquez A, Morales-Chávez C, Aguirre-Olmedo I, Torres-Ruiz F, Rojano-Rodríguez M, Fernández-Álvarez L, Cardenas-Lailson E, Moreno-Portillo M (2016) Laparoscopic hepaticojejunostomy after bile duct injury. Surg Endosc 30(3):876–882CrossRefGoogle Scholar
  14. 14.
    Cuendis-Velázquez A, Bada-Yllán O, Trejo-Ávila M, Rosales-Castañeda E, Rodríguez-Parra A, Moreno-Ordaz A, Cardenas-Lailson E, Rojano-Rodriguez M, Sanjuan-Martinez C, Moreno-Portillo M (2018) Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury. Langenbecks Arch Surg. 403(1):53–59CrossRefGoogle Scholar
  15. 15.
    de Jager E, Levine AA, Udyavar NR, Burstin HR, Bhulani N, Hoyt DB, Ko CY, Weissman JS, Britt LD, Haider AH, Maggard-Gibbons MA (2019) Disparities in surgical access: a systematic literature review, conceptual model, and evidence map. J Am Coll Surg 228(3):276–298CrossRefGoogle Scholar
  16. 16.
    Ríos-Hernández N, Guerrero-Avendaño GML (2018) Lesiones de la vía biliar más frecuentes caracterizadas por colangiografía percutánea. Experiencia en un año en el servicio de radiología intervencionista. An Radiol México 17(1):46–52Google Scholar
  17. 17.
    Gutierrez Perez JO, Medina Garcia P, Ortiz Reyes SF, Lozano Cervantes HE (2011) Lesiones De La Vía Biliar: prevalencia en pacientes con colecistectomía laparoscópica en un hospital de especialidades. Cirugía General. 33(5):38–42Google Scholar
  18. 18.
    Garcia Rodriguez JH, Palacio Vélez F, Castro Mendoza A (2008) Incidencia de lesiones de vía biliar en pacientes de colecistectomía laparoscópica en el hospital “Ignacio Zaragoza” en 12 años. Anales Médicos de la Asociación Médica del Centro Médico ABC. 53(2):69–73Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alexandra Rueda-De-Leon
    • 1
  • Ismael Dominguez-Rosado
    • 1
    Email author
  • Alan G. Contreras
    • 1
  • Mario Vilatoba
    • 1
  • Miguel A. Mercado
    • 1
  1. 1.Department of SurgeryInstituto Nacional de Ciencias Medicas y Nutricion “Salvador Zubiran”Mexico CityMexico

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