Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama.

Fecha de publicación: 12/08/2022 Fecha Ahead of Print: 12/08/2022

Autores de IIS La Fe

Javier Maupoey Ibáñez

Autor
Rafael López Andújar

Autor

Participantes ajenos a IIS La Fe

Lopez-Lopez, Victor
Kuemmerli, Christoph
Cutillas, Jose
Ramos, Emilio
Mils, Kristel
Valdivieso, Andres
Valero AP
Martinez PA
Paterna, Sandra
Serrablo, Alejando
Reese, Tim
Oldhafer, Karl
Brusadin, Roberto
Conesa AL
Valladares LD
Loinaz, Carmelo
Garces-Albir, Marina
Sabater, Luis
Mocchegiani, Federico
Vivarelli, Marco
Pérez SA
Flores, Benito
Lucena JL
Sanchez-Cabus, Santiago
Calero, Alicia
Minguillon, Antonio
Ramia JM
Alcazar, Candido
Aguilo, Javier
Ruiperez-Valiente, Jose A.
Grochola LF
Clavien, Pierre-Alain
Petrowsky, Henrik
Robles-Campos, Ricardo

Grupos

Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

Abstract

BACKGROUND: The management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery. METHODS: This was a multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes. RESULTS: A total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P = .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P ? .001). The need for vascular reconstruction was associated with higher mortality (P = .04). Two of the 4 patients transplanted died. CONCLUSION: Vascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results.

Datos de la publicación

ISSN/ISSNe:: 0039-6060, 1532-7361
Tipo:: Article
Páginas:: 1067-1075
DOI:: 10.1016/j.surg.2022.06.020
PubMed:: 35965144
Factor de Impacto:: 1,236 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Lopez-Lopez, Victor:: Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
Kuemmerli, Christoph:: Department of Surgery and Transplantation, University Hospital Zurich, Switzerland

Department of Surgery, Clarunis - University Center for Gastrointestinal and Liver Diseases Basel, Switzerland
Cutillas, Jose:: Department of General Surgery, Hospital Francesc de Borja, Gandía, Valencia, Spain
Maupoey, Javier:: Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
Lopez-Andujar, Rafael:: Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
Ramos, Emilio:: Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
Mils, Kristel:: Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
Valdivieso, Andres:: Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
Valero AP:: Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
Martinez PA:: Department of Information and Communication Engineering, Universidad de Murcia, Spain
Paterna, Sandra:: Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
Serrablo, Alejando:: Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
Reese, Tim:: Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany
Oldhafer, Karl:: Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany
Brusadin, Roberto:: Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
Conesa AL:: Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
Valladares LD:: Department of Surgery, Hepatopancreatobiliary Unit, Hospital Clínico San Carlos, Madrid, Spain
Loinaz, Carmelo:: Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario, 12 de Octubre, Madrid, Spain
Garces-Albir, Marina:: Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Spain
Sabater, Luis:: Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Spain
Mocchegiani, Federico:: Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
Vivarelli, Marco:: Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
Pérez SA:: Department of Surgery, Morales University Hospital, Madrid, Spain
Flores, Benito:: Department of Surgery, Morales University Hospital, Madrid, Spain
Lucena JL:: Department of Surgery, Puerta del Hierro University Hospital, Madrid, Spain
Sanchez-Cabus, Santiago:: Hepatobiliopancreatic Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
Calero, Alicia:: Department of General Surgery, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
Minguillon, Antonio:: Department of General Surgery, Obispo Polanco Hospital, Teruel, Spain
Ramia JM:: Department of Surgery, University Hospital of Alicante, Spain

Universidad Miguel Hernandez, Alicante, Spain
Alcazar, Candido:: Department of Surgery, University Hospital of Alicante, Spain

Universidad Miguel Hernandez, Alicante, Spain
Aguilo, Javier:: Department of General Surgery, Hospital Lluís Alcanyís Hospital, Xàtiva, Valencia, Spain
Ruiperez-Valiente, Jose A.:: Department of Information and Communication Engineering, Universidad de Murcia, Spain
Grochola LF:: Clinic for Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Switzerland
Clavien, Pierre-Alain:: Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
Petrowsky, Henrik:: Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
Robles-Campos, Ricardo:: Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain

Keywords

BILE-DUCT INJURY; HEPATIC-ARTERY INJURY; LAPAROSCOPIC CHOLECYSTECTOMY; VASCULOBILIARY INJURY; LIVER-TRANSPLANTATION; MAJOR HEPATECTOMY; BILIARY INJURY; MANAGEMENT; COMPLICATIONS; IMPACT