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Editorial
Role of Video-assisted Laparoscopy in the Management of Iatrogenic Bile Duct Injuries
Papel de la video laparoscopia en el manejo de lesiones quirúrgicas de la vía biliar
Juan Pekolja,
Corresponding author
juan.pekolj@hotmail.com

Corresponding author.
, Julián Dragob
a Unidad de Trasplante Hepático, Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
b Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Due to its medical and legal implications&#44; iatrogenic bile duct injury &#40;IBDI&#41; continues to be one of the complications feared most by both general surgeons and surgical specialists&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">After the initial rise in its incidence with the advent of laparoscopy&#44; IBDI rates have progressively declined in recent decades&#44; and in some series they are now comparable to the historical rates of open cholecystectomies&#46; Today&#44; the incidence of IBDI ranges from 0&#46;2 to 0&#46;3&#37; at referral hospitals&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We must realize that IBDI is a complication that always has and always will accompany cholecystectomy&#46; The main objectives for its management are&#58; to minimize its incidence&#59; to increase intraoperative diagnosis and treatment by trained surgeons&#59; and to achieve excellent long-term repair results&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The significant morbidity of IBDI means that these lesions are of great importance&#44; and they are always among the most relevant issues in surgical practice&#46; In their evolution&#44; they can lead to sepsis&#44; liver failure and even patient death&#46; Therefore&#44; these complications should be treated ideally from onset at high-volume referral centers&#44; where all therapeutic options are available&#44; among them video-assisted laparoscopy&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We will divide the following editorial into 3 sections&#44; each dealing with different aspects of video-assisted laparoscopy&#58; 1&#41; intraoperative management of IBDI&#59; 2&#41; postoperative management of IBDI&#59; and 3&#41; deferred treatment of IBDI&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Intraoperative Management of Iatrogenic Bile Duct Injuries</span><p id="par0030" class="elsevierStylePara elsevierViewall">The most relevant prognostic factor when defining the prognosis of IBDI is whether the damage was identified during surgery or not&#46; Repair during the operation itself is associated with a higher rate of long-term effectiveness&#44; lower morbidity and lower healthcare costs&#44; as well as a lower litigation rate&#46; In fact&#44; there are studies that compared the quality of life between cholecystectomies with IBDI and intraoperative repair versus cholecystectomies with no complications&#44; finding no statistically significant differences&#46; The intraoperative detection of IBDI presents great variability&#44; ranging from 15 to 89&#37; depending on the series analyzed&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;6&#8211;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We believe it is relevant to mention the impact of intraoperative cholangiography &#40;IOC&#41; at this point&#46; Even though population studies have shown that IOC decreases the incidence of injuries&#44; we consider that its most important role is to diagnose injuries during surgery&#44; avoid progression of the damage and define its intraoperative treatment&#44; thus decreasing the morbidity and mortality of IBDI&#46; In our experience&#44; we had 23 IBDI out of a total of 15&#44;473 cholecystectomies performed &#40;0&#46;14&#37;&#41;&#44; and 21 of them &#40;91&#37;&#41; were satisfactorily identified and treated intraoperatively&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As for intraoperative repair in cases where there was no thermal mechanism of biliary injury and the tissues to be repaired are vital and have correct blood supply&#44; partial divisions should be sutured either with or without placement of external biliary drainage or stents&#44; depending on the extension&#46; In cases of complete bile duct division&#44; we recommend end-to-end suture with external biliary drainage or stents&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In contrast&#44; if there is associated thermal damage&#44; we are faced with a situation where it is very difficult to establish the magnitude and extent of the injury&#44; and where the surgeon&#8217;s experience in repairing IBDI is of utmost importance&#46; If no experienced surgeon is available for the repair&#44; we recommend placing an external biliary drain with subphrenic drain tubes&#44; followed by prompt referral to a specialized hospital&#46; This last point is perhaps the most relevant of all&#58; when there is no experience in IBDI repair&#44; no further dissection of the bile duct or ligation are recommended&#46; The objective in this situation must be to avoid 3 serious complications&#58; choleperitoneum&#44; biloma and cholangitis&#46; This is achieved by performing a thorough washing and placing the drains as described &#40;&#8216;place drains and leave&#8217;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;7&#44;8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">If a specialized surgeon is available&#44; we recommend performing a proximal resection of the bile duct of several centimeters to ensure vitality in the biliary end and reconstruction with a Roux-en-Y hepaticojejunal anastomosis&#44; using delicate sutures &#40;7&#47;0&#41; and under magnification as we routinely do in biliary reconstructions during liver transplantation&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The repair approach may be laparoscopic or open&#44; depending on the surgeon&#8217;s experience&#44; characteristics of the injury and patient condition&#46; In our own series mentioned previously&#44; we decided to convert to open surgery for repair in 11 cases &#40;52&#37;&#41;&#44; while repairing 10 cases &#40;48&#37;&#41; laparoscopically&#44; which demonstrates the usefulness of this approach in the repair of IBDI&#46; In 81&#37; of the cases&#44; the surgeon who repaired the injury was not the surgeon who caused it&#46; This avoids the emotional component that weighs on the surgeon who caused the injury&#44; a fact that can distort subsequent decision-making and the final evolution of the case&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Postoperative Management of Iatrogenic Bile Duct Injuries</span><p id="par0060" class="elsevierStylePara elsevierViewall">Depending on the time of diagnosis and the general patient and local tissue conditions&#44; different therapeutic possibilities will be considered&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the case of early diagnosis&#44; when the general condition of the patient is adequate and the tissues are not very compromised&#44; all the concepts described in the previous section will be applied&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">On the other hand&#44; if the patient&#8217;s general condition is compromised and the diagnosis is made late&#44; the therapeutic strategy will be different&#46; Once an IBDI becomes established&#44; the management of cholangitis&#44; biloma and choleperitoneum is of utmost importance&#44; as they can lead the patient to sepsis&#44; organ failure and death&#46; This&#44; the approach will vary depending on the patient&#8217;s clinical state&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In the case of cholangitis&#44; percutaneous or endoscopic drainage of the bile duct achieve initial control in most cases&#46; For localized intra-abdominal collections &#40;&#8216;bilomas&#8217;&#41;&#44; percutaneous drainage is the solution&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The appearance of choleperitoneum leads to the need for re-operation&#46; It should be noted that it usually presents with serious symptoms&#44; which should not be minimized and require quick action&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In our experience&#44; the laparoscopic approach of postoperative choleperitoneum due to IBDI is of choice&#46; Its early application determines less patient deterioration at the time of the exploration&#44; as well as less use of complementary diagnostic imaging methods&#44; making laparoscopy a cost-efficient procedure for the management of patients with postoperative complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The laparoscopic approach allows for correct peritoneal lavage&#46; It also makes a new cholangiography possible&#44; which is essential to delimit the biliary anatomy and rule out causes of bile duct hypertension &#40;residual lithiasis&#41;&#46; With this approach&#44; the site of the biliary leak can be identified and small IBDI repairs can be performed&#46; However&#44; we should clarify that&#44; to our understanding&#44; this procedure is not the time to definitively repair the IBDI&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">During the operation&#44; the entire abdominal cavity should be thoroughly washed in order to control the septic state of the patient&#46; Then&#44; the site of the bile leak should be found&#44; while also inspecting the duodenum and small intestine&#44; as injuries to these organs often present similar symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">If there is a small injury at the level of the cystic&#44; common hepatic or common bile ducts&#44; lavage and drainage are often the only interventions needed to repair the lesion&#44; accompanied by endoscopic papillotomy in order to reduce intraluminal pressure&#46; In this manner&#44; the definitive resolution of symptoms will often be observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Deferred Repair of Bile Duct Injuries</span><p id="par0105" class="elsevierStylePara elsevierViewall">For the ideal repair of an IBDI&#44; 3 factors are necessary&#58; a patient in good general condition &#40;not infected and well-nourished&#41;&#44; tissues in good condition&#44; and a surgeon with experience in hepatobiliary and pancreatic &#40;HBP&#41; surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The best time to make deferred repair is a controversial issue&#46; Ideally&#44; there are 3 different moments in which it is possible&#58; 1&#41; early &#8211; up until 7 days after the damage has occurred&#59; 2&#41; intermediate &#8211; after 7 days and up to 6 weeks&#59; and 3&#41; late &#8211; after more than 6 weeks&#46; The best results in terms of morbidity and resolution of symptoms have been seen in the early and late groups&#44; making these 2 the best times to perform the repair&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;11&#44;12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the type of approach to be carried out&#44; although laparotomy is the most frequent approach for the definitive resolution of IBDI&#44; laparoscopy has presented increasingly better results in different series and is gaining ground in the management of IBDI&#46; The choice of this route will fundamentally depend on the type of injury and the experience of the surgeon&#46; The ideal biliodigestive anastomosis is Roux-en-Y hepaticojejunal anastomosis&#46; The laparoscopic approach is indicated preferably for the elective management of lesions&#44; with a bile duct of adequate caliber&#44; when the regional anatomy exposure allows and the surgeon has experience in advanced laparoscopic surgery and in the management of laparoscopic suture and knotting techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;5&#44;13</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Biliary repair with robotic surgery has shown good results in several series&#44; due in large part to the greater range of movements that the robot provides compared to laparoscopy&#46; The cost-effectiveness of this approach has yet to be defined&#46; It will become more promising as robotic surgery gains more ground and becomes more economically accessible&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Complex injuries with compromise of the confluence and those with associated vascular lesions or multiple previous attempts at repair should be treated using the open approach&#46; Patients with these injuries should be treated exclusively by HPB referral units with extensive experience&#44; very good results and high rates of resolution&#46; Liver resection may sometimes be required for treatment&#46; Laparoscopic liver resections have recently been described for the resolution of IBDI&#44; providing very good short-term results&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Summary</span><p id="par0130" class="elsevierStylePara elsevierViewall">Video-assisted laparoscopy plays a growing role at 3 stages during the management of IBDI&#58; 1&#41; during intraoperative identification and repair&#59; 2&#41; during the management of postoperative choleperitoneum&#59; and 3&#41; during delayed biliary repair&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">This approach has shown very good long-term results in several international publications&#44; with the perioperative advantages of the minimally invasive approach&#46;</p></span></span>"
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                    0 => array:2 [
                      "titulo" => "Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury"
                      "autores" => array:1 [
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                          "autores" => array:6 [
                            0 => "F&#46;A&#46; Alvarez"
                            1 => "M&#46; de Santiba&#241;es"
                            2 => "M&#46; Palavecino"
                            3 => "R&#46; S&#225;nchez Clari&#225;"
                            4 => "O&#46; Mazza"
                            5 => "G&#46; Arbues"
                          ]
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1002/bjs.9486"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2014"
                        "volumen" => "101"
                        "paginaInicial" => "677"
                        "paginaFinal" => "684"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24664658"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laparoscopic repair of post-cholecystectomy bile duct injury&#58; an advance in surgical management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Dokmak"
                            1 => "N&#46; Amharar"
                            2 => "B&#46; Aussilhou"
                            3 => "F&#46; Cauchy"
                            4 => "A&#46; Sauvanet"
                            5 => "J&#46; Belghiti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11605-017-3400-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastrointest Surg"
                        "fecha" => "2017"
                        "volumen" => "21"
                        "paginaInicial" => "1368"
                        "paginaFinal" => "1372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28349333"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraoperative management and repair of bile duct injuries sustained during 10&#44;123 laparoscopic cholecystectomies in a high-volume referral center"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Pekolj"
                            1 => "F&#46;A&#46; Alvarez"
                            2 => "M&#46; Palavecino"
                            3 => "R&#46; S&#225;nchez Clari&#225;"
                            4 => "O&#46; Mazza"
                            5 => "E&#46; de Santiba&#241;es"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jamcollsurg.2013.01.051"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Surg"
                        "fecha" => "2013"
                        "volumen" => "216"
                        "paginaInicial" => "894"
                        "paginaFinal" => "901"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23518251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Cuendis-Vel&#225;zquez"
                            1 => "O&#46; Bada-Yll&#225;n"
                            2 => "M&#46; Trejo-&#193;vila"
                            3 => "E&#46; Rosales-Casta&#241;eda"
                            4 => "A&#46; Rodr&#237;guez-Parra"
                            5 => "A&#46; Moreno-Ordaz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Langenbecks Arch Surg"
                        "fecha" => "2018"
                        "volumen" => "403"
                        "paginaInicial" => "53"
                        "paginaFinal" => "59"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role for laparoscopy in the management of bile duct injuries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46; Gupta"
                            1 => "S&#46; Jayaraman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1503/cjs.003317"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Surg"
                        "fecha" => "2017"
                        "volumen" => "60"
                        "paginaInicial" => "300"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28930036"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality-of-life after bile duct injury&#58; intraoperative detection is crucial&#46; A national case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46;L&#46; Rystedt"
                            1 => "A&#46;K&#46; Montgomery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hpb.2016.09.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "HPB"
                        "fecha" => "2016"
                        "volumen" => "18"
                        "paginaInicial" => "1010"
                        "paginaFinal" => "1016"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27773464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complicaciones m&#225;s frecuentes de la cirug&#237;a biliar"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                    0 => array:1 [
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                        "titulo" => "Complicaciones de la cirug&#237;a abdominal&#58; c&#243;mo manejarlas"
                        "paginaInicial" => "467"
                        "paginaFinal" => "519"
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                  ]
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            7 => array:3 [
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                    0 => array:2 [
                      "titulo" => "Specialist outreach service for on-table repair of iatrogenic bile duct injuries&#8212;a new kind of &#8220;travelling surgeon&#8221;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "C&#46; Coldham"
                            2 => "A&#46;D&#46; Mayer"
                            3 => "S&#46;R&#46; Bramhall"
                            4 => "J&#46;A&#46;C&#46; Buckels"
                            5 => "D&#46;F&#46; Mirza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1308/003588408X261663"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann R Coll Surg Engl"
                        "fecha" => "2008"
                        "volumen" => "90"
                        "paginaInicial" => "243"
                        "paginaFinal" => "246"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18430341"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "timing of surgical repair after bile duct injury impacts postoperative complications but not anastomotic patency"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46; Dominguez-Rosado"
                            1 => "D&#46;E&#46; Sanford"
                            2 => "J&#46; Liu"
                            3 => "W&#46;G&#46; Hawkins"
                            4 => "m&#46;a&#46; Mercado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0000000000001868"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2016"
                        "volumen" => "264"
                        "paginaInicial" => "544"
                        "paginaFinal" => "553"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27433902"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved outcomes of bile duct injuries in the 21st century"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;A&#46; Pitt"
                            1 => "S&#46; Sherman"
                            2 => "M&#46;S&#46; Johnson"
                            3 => "A&#46;N&#46; Hollenbeck"
                            4 => "J&#46; Lee"
                            5 => "M&#46;R&#46; Daum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e3182a1b25b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2013"
                        "volumen" => "258"
                        "paginaInicial" => "490"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24022441"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complex bile duct injuries&#58; management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; de Santib&#225;&#241;es"
                            1 => "V&#46; Ardiles"
                            2 => "J&#46; Pekolj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/13651820701883114"
                      "Revista" => array:6 [
                        "tituloSerie" => "HPB"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "4"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18695753"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bile duct injuries&#58; management of late complications"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; de Santiba&#241;es"
                            1 => "M&#46; Palavecino"
                            2 => "V&#46; Ardiles"
                            3 => "J&#46; Pekolj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00464-006-0491-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "1648"
                        "paginaFinal" => "1653"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17063285"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "13"
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                    0 => array:2 [
                      "titulo" => "Reconstruction&#47;repair of iatrogenic biliary injuries&#58; is the robot offering a new option&#63; Short clinical report"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "P&#46; Quadri"
                            2 => "S&#46; Durgam"
                            3 => "F&#46;M&#46; Bianco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1097/SLA.0000000000002343"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2018"
                        "volumen" => "267"
                        "paginaInicial" => "e7"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
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es en pt

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