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.
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Article info
Publication history
Published online: August 12, 2022
Accepted:
June 27,
2022
Footnotes
Victor Lopez-Lopez, MD, PhD, and Christoph Kuemmerli, MD, share first authorship. Henrik Petrowsky, MD, PhD, and Ricardo Robles-Campos, MD, PhD, are co-senior authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
