Trial design and participants
PTD, Sepsis, cholangitis, inflammation, cholestasis, sepsis, post-cholecystectomy
SEPSIS, CHOLANGITIS, INFLAMMATION, CHOLESTASIS, SEPSIS
This study included all consecutive patients treated with an HJ for post-cholecystectomy BDI from February 2014 to January 2022 in 10 tertiary centres in Egypt. The inclusion criteria included patients diagnosed with type E1 to E4 BDIGroup A (Early reconstruction without sepsis control): all the included patients were operated on just after stabilization of the general condition (within 24 h).Group B (Early reconstruction with sepsis control): if the patients were presented with sepsis manifestations, expeditious sepsis control was achieved first, then reconstruction was performed. Sepsis control was obtained using broad-spectrum antibiotics, aggressive fluid resuscitation, and proper biliary and abdominal drainage. ICU admission with occasional pressors and transfusion might be indicatedGroup C (Delayed reconstruction): if the patients were presented with an abdominal collection, a preoperative ultrasound-guided tubal drainage was done to allow portal inflammation to subside until the planned reconstruction time. Re-laparoscopy or re-laparotomy for wash and drainage was required for patients with an excessive abdominal collection. Also, a biliary tree decompression by percutaneous transhepatic drain (PTD) was done in patients with cholangitis and/or long-standing cholestasis