Complications in hepato-pancreato-biliary surgery : Multidisciplinary and interdisciplinary approach

The aim of this thesis was to contribute to improved surgical outcomes for patients undergoing hepato-pancreato-biliary surgery in a cross-disciplinary manner. In part 1 of this thesis, we assessed treatment options of bile duct injury. Outcomes of a percutaneous-endoscopic rendezvous procedure were assessed, demonstrating a technical success rate of 94% and a long-term success rate of 55%. Furthermore, the optimal timing of surgical reconstruction for BDI is discussed, as well as the long-term impact of BDI and treatment of anastomotic strictures. In part 2 of this thesis we aimed to weigh risks and benefits of several surgical procedures on the biliary tract. Outcomes of a choledochoduodenostomy were compared to outcomes of a hepaticojejunostomy in a matched case-control analysis, demonstrating a higher incidence of anastomotic strictures following hepaticojejunostomy. In a multicenter retrospective analysis of patients undergoing resection of a choledochoduodenostomy, the incidence of biliary malignancies was 11%. In a retrospective analysis of patients with a “mid-bile duct cholangiocarcinoma” we found that local resection resulted in less morbidity and comparable survival compared to a pancreatoduodenectomy. The third part of this thesis described the development of a program in which relatives of patients undergoing major abdominal surgery were actively involved in postoperative care of their loved ones, with a focus on care activities that have the potential to reduce the risk of certain complications. We found that this program was feasible and positively appreciated by patients, relatives, nurses and doctors. Patients participating in the program mobilized more and showed more adherence to breathing exercises, oral hygiene and cognitive activities. These results are promising and give rise to a larger study assessing the effect of this program on patient outcomes.