Disparities in bile duct injury care
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.
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.
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.
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.
KeywordsBile duct Patency Primary repair Re-repair
Compliance with ethical standards
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.
- 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
- 8.Data for Upper middle income, Mexico. The World Bank. https://data.worldbank.org/income-level/upper-middle-income. Accessed 03 Jan 2019
- 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
- 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
- 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.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.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