Çoğal İbrahim, Yavuz Burak, Kaycı Yunus, Topal Uğur, Aydın İshak, Saritas Ahmet Gokhan, Dalci Kubilay, Eray İsmail Cem, Akcam Atilgan Tolga, Ülkü Abdullah
Department of General Surgery, Cukurova University Faculty of Medicine, Adana, Türkiye.
Front Surg. 2025 Jul 3;12:1576454. doi: 10.3389/fsurg.2025.1576454. eCollection 2025.
Cholecystectomy is the most common elective abdominal surgery globally. With the advent of laparoscopy, laparoscopic cholecystectomy has become the gold standard. However, this has also led to an increase in biliary tract injuries, a complication with high morbidity and mortality that requires a multidisciplinary treatment approach. This study aims to identify factors influencing postoperative outcomes in patients undergoing surgical repair for biliary tract injuries.
This study included 66 patients referred to the General Surgery Department of Çukurova University Medical Faculty for biliary tract injuries between January 2005 and June 2022, all of whom underwent hepaticojejunostomy. Demographic data, pre- and post-operative lab values, imaging, and anastomosis types were recorded and analyzed. Early and long-term postoperative outcomes were examined, using the McDonald classification for long-term follow-up.
Of the 66 patients, 18 (27.3%) were male, and 48 (72.7%) were female, with a mean follow-up of 105 ± 58 months. Early postoperative complications developed in 28 patients (42.4%). Diabetes and culture positivity were significantly associated with wound infections. Elevated pre- and post-repair ALP and GGT levels were significantly associated with poorer long-term outcomes according to the McDonald classification. Vascular injury was significantly associated with isolated ALP-GGT elevation. Anastomotic stricture developed in 8 patients (12.1%). Of these, 2 (3%) were successfully managed with balloon dilation.
Biliary tract injury is a serious complication post-cholecystectomy, requiring a multidisciplinary approach and follow-up in a hepatobiliary center. Surgeon experience and local risk factors are crucial in managing these injuries.
胆囊切除术是全球最常见的择期腹部手术。随着腹腔镜技术的出现，腹腔镜胆囊切除术已成为金标准。然而，这也导致了胆道损伤的增加，这是一种发病率和死亡率都很高的并发症，需要多学科治疗方法。本研究旨在确定影响接受胆道损伤手术修复患者术后结局的因素。
本研究纳入了2005年1月至2022年6月间因胆道损伤转诊至库库罗瓦大学医学院普通外科的66例患者，所有患者均接受了肝空肠吻合术。记录并分析人口统计学数据、术前和术后实验室检查值、影像学检查及吻合类型。采用麦克唐纳分类法进行长期随访，检查术后早期和长期结局。
66例患者中，男性18例（27.3%），女性48例（72.7%），平均随访时间为105±58个月。28例患者（42.4%）发生了术后早期并发症。糖尿病和培养阳性与伤口感染显著相关。根据麦克唐纳分类法，修复前后碱性磷酸酶（ALP）和γ-谷氨酰转肽酶（GGT）水平升高与较差的长期结局显著相关。血管损伤与单纯ALP-GGT升高显著相关。8例患者（12.1%）发生吻合口狭窄。其中2例（3%）通过球囊扩张成功治疗。
胆道损伤是胆囊切除术后的严重并发症，需要多学科方法并在肝胆中心进行随访。外科医生经验和局部危险因素在处理这些损伤中至关重要。
