Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Lopez-Lopez Victor, Kuemmerli Christoph, Cutillas Jose, Maupoey Javier, López-Andujar Rafael, Ramos Emilio, Mils Kristel, Valdivieso Andres, Valero Arkaitz Perfecto, Martinez Pedro Antonio, Paterna Sandra, Serrablo Alejando, Reese Tim, Oldhafer Karl, Brusadin Roberto, Conesa Asunción López, Valladares Luis Díez, Loinaz Carmelo, Garcés-Albir Marina, Sabater Luis, Mocchegiani Federico, Vivarelli Marco, Pérez Sergio Annese, Flores Benito, Lucena Jose Luis, Sánchez-Cabús Santiago, Calero Alicia, Minguillon Antonio, Ramia Jose Manuel, Alcazar Cándido, Aguilo Javier, Ruiperez-Valiente Jose A, Grochola Lukasz Filip, Clavien Pierre-Alain, Petrowsky Henrik, Robles-Campos Ricardo
Аннотация
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.