Iatrogenic Bile Duct Injuries Observed during Endoscopic Retrograde Cholangiogram; Is There a Change with More Formal Training in Laparoscopic Surgery

Abstract

AttachedIntroduction The incidence o f iatrogenic bile d u ct Injuries (IB D I) has ch an ge d in th e recent past. In Sri Lanka th e current gen eration o f su rge o n s have had form al training in lap aroscopy ch olecystectom y (LC) co m p are d to th o se in the introductory period, w e analyzed the patterns o f IB D I detected d u rin g ERC d u rin g tw o tim e pe riods (2003- 2 0 1 0 an d 2011 to date) for a n y significant differences in injury patterns. M ethods Retrospective analysis o f th e ERC fin d ings o f patients 'w ith IBD I from 2003 to 2016 w as d o n e in a tertiary care unit. Injuries w ere categorized by B ism uth -Strasb e rg d assification(A -E). E( 1-5) w ere considered as m ajor injuries. Results O v e r 13 years, 87 patients w ith IB D I w ere referred *:r ERC. M a jo rity (8 0 % ) w ere fem ales. M e a n age w as years (range 17-81). In the early period (2003-2211 o n ly 5 5 % o f injuries w ere due to LC, w hile 7 7 % v.e~ w ith LC in the latter period (p=0.02). In the early pe r :-z 6 7 % w ere m ajor injuries (B ism uth E 1-5) w hile -~ - w ere m ajor in th e post-2 0 1 0 gro u p (p=0.047; : * univariate analysis. H ow e ve r in am ultifacto rial anai .s there w a s no difference in the injury severity b ase c :* t h e t im e p e r io d ( p = 0 . 0 6 8 ) o r t h e t y p e : siirgefy(p=0.271). C onve rsion rates to open surge* a n d th e fr a c t io n o f in ju rie s n e e d in g s u r g is s reconstruction w ere n o t significantly different betwee * periods. Conclusion The prop ortion o f IBD I d u e to LC, co m pare d to ope * surgery has risen significantly. Form al training in _1 ap p e ars not to have affected the severity o f IB I conversion rate o r th e percentage o f patients re q u ire j surgical reconstruction . The stu d y is lim ited c inclu ding o n ly IB D ls d ia gn o se d by ERC.