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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 3/2019

01-03-2019 | Original Article

A New Era of Bile Duct Repair: Robotic-Assisted Versus Laparoscopic Hepaticojejunostomy

Authors: Adolfo Cuendis-Velázquez, Mario Trejo-Ávila, Orlando Bada-Yllán, Eduardo Cárdenas-Lailson, Carlos Morales-Chávez, Luis Fernández-Álvarez, Sujey Romero-Loera, Martin Rojano-Rodríguez, Carlos Valenzuela-Salazar, Mucio Moreno-Portillo

Published in: Journal of Gastrointestinal Surgery | Issue 3/2019

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Abstract

Background

Despite scientific evidence of the safety, efficacy, and in some cases superiority of minimally invasive surgery in hepato-pancreato-biliary procedures, there are scarce publications about bile duct repairs. The aim of this study was to compare the outcomes of robotic-assisted surgery versus laparoscopic surgery on bile duct repair in patients with post-cholecystectomy bile duct injury.

Methods

This is a retrospective comparative study of our prospectively collected database of patients with bile duct injury who underwent robotic or laparoscopic hepaticojejunostomy.

Results

Seventy-five bile duct repairs (40 by laparoscopic and 35 by robotic-assisted surgery) were treated from 2012 to 2018. Injury types were as follows: E1 (7.5% vs. 14.3%), E2 (22.5% vs. 14.3%), E3 (40% vs. 42.9%), E4 (22.5% vs. 28.6%), and E5 (7.5% vs. 0), for laparoscopic hepaticojejunostomy (LHJ) and robotic-assisted hepaticojejunostomy (RHJ) respectively. The overall morbidity rate was similar (LHJ 27.5% vs. RHJ 22.8%, P = 0.644), during an overall median follow-up of 28 (14–50) months. In the LHJ group, the actuarial primary patency rate was 92.5% during a median follow-up of 49 (43.2–56.8) months. While in the RHJ group, the actuarial primary patency rate was 100%, during a median follow-up of 16 (12-22) months. The overall primary patency rate was 96% (LHJ 92.5% vs. RHJ 100%, log-rank P = 0.617).

Conclusion

Our results showed that the robotic approach is similar to the laparoscopic regarding safety and efficacy in attaining primary patency for bile duct repair.
Literature
1.
Winslow ER, Fialkowski EA, Linehan DC, Hawkins WG, Strasberg SM. “Sideways”: result of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. Ann Surg 2009; 249: 426–434.CrossRefPubMed
2.
Cuendis-Velázquez A, Morales-Chávez C, Aguirre-Olmedo I, Torres-Ruiz F, Rojano-Rodríguez M, Fernández-Alvarez L, et al. Laparoscopic hepaticojejunostomy after bile duct injury. Surg Endosc 2016; 30: 876-882.CrossRefPubMed
3.
Cuendis-Velázquez A, Bada-Yllán O, Trejo-Ávila M, Rosales-Castañeda E, Rodríguez-Parra A, Moreno-Ordaz A, et al. Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury. Langenbecks Arch Surg 2018; 403: 53-59.CrossRefPubMed
4.
Savader SJ, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB, et al. Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg 1997; 225: 268-273.CrossRefPubMedPubMedCentral
5.
Pucher PH, Brunt LM, Fanelli RD, Asbun HJ, Aggarwal R. SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc 2015; 29: 3074-3085.CrossRefPubMed
6.
Madani A, Watanabe Y, Feldman LS, Vassiliou MC, Barkun JS, Fried GM, et al. Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy. J Am Coll Surg 2015; 221: 931-940.e8.CrossRefPubMed
7.
Altieri MS, Yang J, Obeid N, Zhu C, Talamini M, Pryor A. Increasing bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years: an analysis of outcomes in New York State. Surg Endosc 2018; 32: 667-674.CrossRefPubMed
8.
Hepp J, Couinaud C. Approach to and use of the left hepatic duct in reparation of the common bile duct. Presse Medicale 1956; 64: 947–948.PubMed
9.
Hepp J. Hepaticojejunostomy using the left biliary trunk for iatrogenic biliary lesions: the French connection. World J Surg. 1985; 9: 507–511.CrossRefPubMed
10.
Couinaud C. Le Foie. Etudes Anatomiques et Chirugicales. 1957, Paris: Masson & Cie.
11.
Couinaud C. The vasculo-biliary sheaths. In: Couinaud C, ed. Surgical anatomy of the liver revisited. Paris:Couinaud 1989: 29-39.
12.
Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180: 101–125.PubMed
13.
Strasberg SM, Picus DD, Ja Drebin. Results of a new strategy for reconstruction of biliary injuries having an isolated right-sided component. J Gastrointest Surg 2001; 5: 266–274.CrossRefPubMed
14.
Strasberg SM. Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg. 2008; 15: 284-292.CrossRefPubMed
15.
16.
Lillemoe KD, Martin SA, Cameron JL, Yeo CJ, Talamini MA, Kaushal S, et al. Major bile duct injuries associated with laparoscopic cholecystectomy. Ann Surg 1997; 225: 459-471.CrossRefPubMedPubMedCentral
17.
Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campbell KA, Talamini MA, et al. Postoperative bile duct strictures. Management and outcomes in the 1990s. Ann Surg. 2000; 232: 430-441.CrossRefPubMedPubMedCentral
18.
Melton GB, Lillemoe KD, Cameron JL, Sauter PA, Coleman J, Yeo CJ. Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life. Ann Surg 2002; 235: 888-895.CrossRefPubMedPubMedCentral
19.
Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy. Peroperative results in 200 patients. Ann Surg 2005; 241: 786-795.CrossRefPubMedPubMedCentral
20.
Mercado MA, Orozco H, de la Garza L, López-Martinez LM, Contreras A, Guillen-Navarro E. Biliary duct injury: partial segment IV resection for intrahepatic reconstruction of biliary lesions. Arch Surg 1999; 134: 1008–1010.CrossRefPubMed
21.
Mercado MA, Chan C, Orozco H, Tielve M, Hinojosa CA. Acute bile duct injury. The need for a high repair. Surg Endosc 2003; 17: 1351–1355.CrossRefPubMed
22.
Mercado MA, Orozco H, Chan C, Quezada C, Barajas-Olivas A, Borja-Cacho D, et al. Bile duct growing factor: An alternative technique for reconstruction of thin bile ducts after iatrogenic injury. J Gastrointest Surg 2006; 10: 1164-1169.CrossRefPubMed
23.
Mercado MA, Chan C, Orozco H, Villalta JM, Barajas-Olivas A, Eraña J, et al. Long-term evaluation of biliary reconstruction after partial liver resection of segments IV and V in iatrogenic injuries. J Gastrointest Surg. 2006; 10: 77– 82.CrossRefPubMed
24.
Mercado MA, Franssen B, Domínguez I, Arriola-Cabrera JC, Ramirez-Del Val F, Elnecavé-Olaiz A, et al. Transition from a low-to a high-volume center bile duct repair: changes in technique and improved outcome. HPB (Oxford) 2011; 13: 767–773.CrossRef
25.
Dominguez-Rosado I, Sanford DE, Liu J, Hawkins WG, Mercado MA. Timing of surgical repair after bile duct injury impacts postoperative complications but not anastomotic patency. Ann Surg 2016; 264: 544-553.CrossRefPubMed
26.
Cuendis-Velázquez A, Trejo-Ávila ME, Rodríguez-Parra A, Bada-Yllán O, Morales-Chávez C, Fernández-Álvarez L, et al. Minimally invasive approach (robotic and laparoscopic) to biliary-enteric fistula secondary to cholecystectomy bile duct injury. J Robot Surg 2017. doi: https://​doi.​org/​10.​1007/​s11701-017-0774-1.
27.
Cuendis-Velazquez A, Trejo-Ávila ME, Rosales-Castañeda E, Cárdenas-Lailson E, Rojano-Rodríguez M, Romero-Loera S, et al. Laparoscopic choledochoduodenostomy. Cir Esp 2017; 95: 397–402.CrossRefPubMed
28.
Cuendis-Velázquez A, Rojano-Rodríguez ME, Morales-Chávez CE, González Angulo-Rocha A, Fernández-Castro E, Aguirre-Olmedo I, et al. Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones. Rev Gastroenterol Mex 2014; 79: 22-27.PubMed
29.
Cho JY, Baron TH, Carr-Locke DL, Chapman WC, Costamagna G, de Santibanes E, et al. Proposed standards for reporting outcomes of treating biliary injuries. HPB (Oxford) 2018; 20: 370-378.CrossRef
30.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213.CrossRefPubMedPubMedCentral
31.
Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018; 25: 17-30.CrossRefPubMed
32.
Cho JY, Jaeger AR, Sanford DE, Fields RC, Strasberg SM. Proposal for Standardized tabular reporting of observational surgical studies illustrated in a study on primary repair of bile duct injuries. J Am Coll Surg 2015; 221: 678-688.CrossRefPubMed
33.
Ismael HN, Cox S, Cooper A, Narula N, Aloia T. The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford) 2017; 19: 352-358.CrossRef
34.
Iannelli A, Paineau J, Hamy A, Schneck AS, Schaaf C, Gugenheim J. Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie. HPB (Oxford) 2013; 15: 611–616.CrossRef
35.
Boerma A, Rauws EA, Keulemans YC, Bergman JJ, Obertop H, Huibregtse K, et al. Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg 2001; 234: 750–757.CrossRefPubMedPubMedCentral
36.
Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 2007; 142: 450–456.CrossRefPubMed
37.
Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR. Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 2002: 60: 39–45.CrossRefPubMed
38.
Gonzalez-Ciccarelli LF, Quadri P, Daskalaki D, Milone L, Gangemi A, Giulianotti PC. Robotic approach to hepatobiliary surgery. Chirurg 2016; 88 (Suppl 1): 19-28.
39.
Prasad A, De S, Mishra P, Tiwari A. Robotic assisted Roux-en-Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury. World J Gastroenterol 2015;21:1703-1706.CrossRefPubMedPubMedCentral
40.
Giulianotti PC, Quadri P, Durgam S, Bianco FM. Reconstruction/repair of iatrogenic biliary injuries, is the robot offering a new option? Short clinical report. Ann Surg 2018; 267:e7-e9.CrossRefPubMed
41.
Wormer BA, Dacey KT, Williams KB, Bradley JF 3rd, Walters AL, Augenstein VA, et al. The first nationwide evaluation of robotic general surgery: a regionalized, small but safe start. Surg Endosc 2014; 28: 767-776.CrossRefPubMed
42.
Dageforde LA, Landman MP, Feurer ID, Poulose B, Pinson CW, Moore DE. A cost-effectiveness analysis of early vs late reconstruction of iatrogenic bile duct injuries. J Am Coll Surg 2012; 214: 919-927.CrossRefPubMed
43.
Yang R, Tao W, Chen YY, Zhang BH, Tang JM, Zhong S, et al. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: A meta-analysis. Int J Surg 2016; 36 (Pt A): 274-282.CrossRefPubMed
Metadata
Title
A New Era of Bile Duct Repair: Robotic-Assisted Versus Laparoscopic Hepaticojejunostomy
Authors
Adolfo Cuendis-Velázquez
Mario Trejo-Ávila
Orlando Bada-Yllán
Eduardo Cárdenas-Lailson
Carlos Morales-Chávez
Luis Fernández-Álvarez
Sujey Romero-Loera
Martin Rojano-Rodríguez
Carlos Valenzuela-Salazar
Mucio Moreno-Portillo
Publication date
01-03-2019
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 3/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-4018-0

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