title: Prognostication of Learning Curve on Surgical Management of Vasculobiliary Injuries after Cholecystectomy.
abstract: Background. Concomitant vascular injury might adversely impact outcomes after iatrogenic bile duct injury (IBDI). Whether a new HPB center should embark upon repair of complex biliary injuries with associated vascular injuries during learning curve is unknown. The objective of this study was to determine outcome of surgical management of IBDI with and without vascular injuries in a new HPB center during its learning curve. Methods. We retrospectively reviewed patients who underwent surgical management of IBDI at our center. A total of 39 patients were included. Patients without (Group 1) and with vascular injuries (Group 2) were compared. Outcome was defined as 90-day morbidity and mortality. Results. Median age was 39 (20-80) years. There were 10 (25.6%) vascular injuries. E2 injuries were associated significantly with high frequency of vascular injuries (66% versus 15.1%) (P = 0.01). Right hepatectomy was performed in three patients. Out of these, two had a right hepatic duct stricture and one patient had combined right arterial and portal venous injury. The number of patients who developed postoperative complications was not significantly different between the two groups (11.1% versus 23.4%) (P = 0.6). Conclusion. Learning curve is not a negative prognostic variable in the surgical management of iatrogenic vasculobiliary injuries after cholecystectomy.
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad 44000, Pakistan.
authors.forename: Abu Bakar
authors.identifier: 0000-0002-4875-603X
authors.initials: AB
authors.lastname: Hafeez Bhatti
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad 44000, Pakistan.
authors.forename: Faisal Saud
authors.initials: FS
authors.lastname: Dar
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad 44000, Pakistan.
authors.forename: Haseeb
authors.initials: H
authors.lastname: Zia
authors.affiliation: Department of Radiology, Shifa International Hospital, Islamabad 44000, Pakistan.
authors.forename: Muhammad Salman
authors.initials: MS
authors.lastname: Rafique
authors.affiliation: Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad 44000, Pakistan.
authors.forename: Nusrat Yar
authors.initials: NY
authors.lastname: Khan
authors.affiliation: Department of Hepatology, Shifa International Hospital, Islamabad 44000, Pakistan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Salih
authors.affiliation: Department of Hepatology, Shifa International Hospital, Islamabad 44000, Pakistan.
authors.forename: Najmul
authors.initials: N
authors.lastname: Hassan Shah