title: [Association between wound size after open cholecystectomy with severity of iatrogenic biliary tract lesions].
abstract: BACKGROUND
  Transoperative biliary tract injury during open or laparoscopic cholecystectomy is a catastrophic event associated with significant morbidity and mortality. Our objective was to determine if wound size during open cholecystectomy is associated with more complex biliary tract injuries.
  
  
  METHODS
  Prospective cohort study performed between March 2006 and February 2007. Sixty-six patients with biliary tract injuries after open cholecystectomy were included. Wound size was analyzed.
  
  
  RESULTS
  Sixty six patients were included, 70% were female with a median age of 44. Seventy four percent were treated for acute cholecystitis. Most participants were overweight or had various degrees of obesity. Biliary tract injuries were not recognized during the primary surgical procedure in 76% of cases. All patients with severe biliary tract injuries (Strasberg E-3 and E-4) had a wound size less than 10 cm in length. Wound size was associated with unrecognized injuries (p=0.000), as well as with injury severity (p=0.000). We were notable to demonstrate a statistically significant association between biliary tract injuries and elective or emergency surgical procedures and midline or subcostal surgical incision for cholecystectomy.
  
  
  CONCLUSIONS
  Our findings suggest that minor surgical access during open cholecystectomy may constitute a risk factor since smaller incisions were associated with more severe biliary tract injuries and an inability to observe this damage during the surgical procedure. We suggest to adhere strictly to the guidelines of an adequate surgical exposure during open cholecystectomy to prevent biliary tract injuries.
authors: Unidad de Investigación en Epidemiología Clínica, Hospital de Especialidades, Centro Médico Nacional de Occidente-IMSS, Guadalajara, Jal., México.
authors: Jacqueline
authors: J
authors: Osuna-Rubio
authors: José Manuel
authors: JM
authors: Hermosillo-Sandoval
authors: Germán
authors: G
authors: López-Guillén
authors: Alejandro
authors: A
authors: Maciel-Miranda
authors: Clotilde
authors: C
authors: Fuentes-Orozco
authors: Andrea Socorro
authors: AS
authors: Alvarez-Villaseñor
authors: Alejandro
authors: A
authors: González-Ojeda
authors: Alejandro
authors: A
authors: López-Ortega
mesh_terms: D000328:Adult; D001659:Biliary Tract / Q000293:injuries* / Q000473:pathology*; D002763:Cholecystectomy / Q000379:methods; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000209:etiology* / Q000473:pathology*; D008297:Male; D011446:Prospective Studies