Cinthia Zapata-López, Department of Research and Teaching, Hospital Juárez de México, Mexico City, Mexico
Victor M. Pinto-Angulo, Department of General Surgeryl, Hospital Juárez de México, Mexico City, Mexico
Irving I. Infante-Montaño, Department of General Surgeryl, Hospital Juárez de México, Mexico City, Mexico
Valeria del C. Toledo-Arellano, Department of Research and Teaching, Hospital Juárez de México, Mexico City, Mexico
Karla S. Zamora-Valencia, Department of Research and Teaching, Hospital Juárez de México, Mexico City, Mexico
Rafael Guzman-Aguilar, Department of General Surgeryl, Hospital Juárez de México, Mexico City, Mexico
Background: Cholelithiasis affects 14.3% in Mexico. Cholecystectomy, mostly laparoscopic due to lower risks and quicker recovery, is the second most common surgery in Mexico. Bile duct injury rates have declined to 0.5-1.2% in the past decade. Objectives: Determine the frequency of bile duct disruption in patients with a Parkland Scale severity grade of 4 or 5 at Hospital Juárez de México, during the period from 2018 to 2024. Methods: A cross-sectional, observational, and retrospective study analyzed medical records and surgical reports of patients with bile duct disruption at Hospital Juárez de México. Results: From 2,167 cholecystectomies performed in 6 years, 329 (15.2%) were classified as Parkland ≥ 4. Of these, 329 (99%) did not experience bile duct disruption, while 5 (1%) did. In total, there were 5 cases of bile duct disruption occurring in-hospital and 18 referred from other centers. Conclusion: In 6 years, 329 difficult cholecystectomies (15.18%) were performed. Of the 6 cases with Parkland classification, 3 (0.138%) were secondary to open total cholecystectomy, 2 (0.092%) to laparoscopic total cholecystectomy, and 1 (0.046%) to open subtotal cholecystectomy. Disruptions were linked to higher Parkland classifications. The mortality rate was 17%, highlighting the need for skilled surgical management to improve outcomes.
Keywords: Bile duct-difficult cholecystectomy. Bile duct disruption. Parkland. Open cholecystectomy. Laparoscopic cholecystectomy.
