PMID- 31427062
OWN - NLM
STAT- MEDLINE
DCOM- 20210927
LR  - 20210927
IS  - 1477-2574 (Electronic)
IS  - 1365-182X (Linking)
VI  - 22
IP  - 3
DP  - 2020 Mar
TI  - Evolution of bile duct repair in a low and middle-income country (LMIC): a 
      comparison of diagnosis, referral, management and outcomes in repair of bile duct 
      injury after laparoscopic cholecystectomy from 1991 to 2004 and 2005-2017.
PG  - 391-397
LID - S1365-182X(19)30623-9 [pii]
LID - 10.1016/j.hpb.2019.07.009 [doi]
AB  - BACKGROUND: There is a paucity of data from the developing world regarding 
      laparoscopic cholecystectomy (LC) bile duct injuries (BDIs), despite the fact 
      that most of the world's population live in a developing country. We assessed how 
      referral patterns, management and outcomes after LC-BDI repair have evolved over 
      time in patients treated at a tertiary referral center in a low and middle-income 
      country (LMIC). METHODS: Patients with LC-BDIs requiring hepaticojejunostomy were 
      identified from a prospective database. Clinical characteristics, geographic 
      distance from referral hospital, timing of referral and repair, and 
      post-operative outcomes were compared in two cohorts treated during 1991-2004 and 
      2005-2017. RESULTS: Of 125 patients, 32 underwent repair in the early period, 93 
      in the latter. There was no difference in demographic or clinical 
      characteristics, but a 45.6% increase in geographically distant referrals in the 
      2005-2017 period. Time from diagnosis to referral and referral to repair 
      increased significantly (p = 0.031, p < 0.001), necessitating more intermediate 
      repairs. Despite this, the number of severe complications decreased (p = 0.022) 
      while long-term outcomes remained unchanged. CONCLUSION: In this study from an 
      LMIC, geographic and logistic constraints necessitated deviation from accepted 
      algorithms devised for well-resourced countries. When appropriately adapted, 
      results comparable to those reported from developed countries are achievable.
CI  - Copyright (c) 2019 International Hepato-Pancreato-Biliary Association Inc. 
      Published by Elsevier Ltd. All rights reserved.
FAU - Lindemann, Jessica
AU  - Lindemann J
AD  - Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical 
      Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa; 
      Department of Surgery, Washington University School of Medicine, Saint Louis, 
      Missouri, USA. Electronic address: lindemannj@wustl.edu.
FAU - Jonas, Eduard
AU  - Jonas E
AD  - Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical 
      Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa.
FAU - Kotze, Urda
AU  - Kotze U
AD  - Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical 
      Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa.
FAU - Krige, Jake E J
AU  - Krige JEJ
AD  - Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical 
      Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20190816
PL  - England
TA  - HPB (Oxford)
JT  - HPB : the official journal of the International Hepato Pancreato Biliary 
      Association
JID - 100900921
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Bile Duct Diseases/*diagnosis/epidemiology/*surgery
MH  - Bile Ducts/*injuries
MH  - Cholecystectomy, Laparoscopic/*adverse effects
MH  - *Developing Countries
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Referral and Consultation
MH  - Retrospective Studies
MH  - South Africa
MH  - Young Adult
EDAT- 2019/08/21 06:00
MHDA- 2021/09/28 06:00
CRDT- 2019/08/21 06:00
PHST- 2019/02/22 00:00 [received]
PHST- 2019/05/30 00:00 [revised]
PHST- 2019/07/19 00:00 [accepted]
PHST- 2019/08/21 06:00 [pubmed]
PHST- 2021/09/28 06:00 [medline]
PHST- 2019/08/21 06:00 [entrez]
AID - S1365-182X(19)30623-9 [pii]
AID - 10.1016/j.hpb.2019.07.009 [doi]
PST - ppublish
SO  - HPB (Oxford). 2020 Mar;22(3):391-397. doi: 10.1016/j.hpb.2019.07.009. Epub 2019 
      Aug 16.