Machado NO. Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome. World J Gastrointest Surg 2016; 8(4): 335-344 [PMID: 27152141 DOI: 10.4240/wjgs.v8.i4.335]
Corresponding Author of This Article
Dr. Norman Oneil Machado, Department of Surgery, Sultan Qaboos University Hospital, PO Box 38, Street 5, Road A, House 19, SQU campus, Muscat 123, Oman. oneilnorman@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2016; 8(4): 335-344 Published online Apr 27, 2016. doi: 10.4240/wjgs.v8.i4.335
Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome
Norman Oneil Machado
Norman Oneil Machado, Department of Surgery, Sultan Qaboos University Hospital, Muscat 123, Oman
Author contributions: The author was involved in the conception, design, acquisition of data, drafting of the article related to intellectual content of the manuscript and final approval.
Conflict-of-interest statement: There is no conflict of interest or potential bias in the study design, interpretation of results or presentation of scientific medical content. Moreover there is no commercial, personal, political, intellectual or religious interest in this article.
Data sharing statement: The technical appendix is available from the corresponding author - oneilnorman@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Norman Oneil Machado, Department of Surgery, Sultan Qaboos University Hospital, PO Box 38, Street 5, Road A, House 19, SQU campus, Muscat 123, Oman. oneilnorman@gmail.com
Telephone: +968-24-413851 Fax: +968-24-413851
Received: May 2, 2015 Peer-review started: May 8, 2015 First decision: August 4, 2015 Revised: November 24, 2015 Accepted: February 23, 2016 Article in press: February 24, 2016 Published online: April 27, 2016 Processing time: 353 Days and 20.1 Hours
Core Tip
Core tip: Inadvertent duodenal injury is a rare potentially fatal complication of laparoscopic cholecystectomy. Such injuries often go unrecognized at the time of the procedure and manifest later with significant morbidity and mortality. Literature review revealed 74 cases of duodenal injury. The injury was caused by cautery in 46%, dissection in 39% and retraction in 14% of the cases. The predominant site of injury was to the 2nd part in 61% and in 31% to 1st part. Duodenorapphy was the primary treatment carried out in 63% of the cases among which 21% was laparoscopically. When detected on table, 88.9% survived in contrast to 76.5% detected later. Overall mortality was 18%. The major impact of this review in clinical practice is in emphasizing the need for prompt detection of a potential duodenal injury in every patient who has unexplained postoperative course following a difficult laparoscopic cholecystectomy due to gall bladder adhesions or dissection. The change of clinical practice it should lead to is an attempt by surgeons in early detection of potential duodenal injury in such patients, which could be achieved by estimating the amylase content in subhepatic fluid collection or by upper gastrointestinal contrast studies. It also highlights the need for immediate surgical repair as any delay beyond the first postoperative day has adverse effect on outcome.
