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Long-term results of secondary biliary repair for cholecystectomy-related bile duct injury: results of a tertiary referral center.

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Navez, Julie [UCL] Gigot, Jean-François [UCL] Deprez, Pierre Henri [UCL] Goffette, Pierre [UCL] Annet, Laurence [UCL] Zech, Francis [UCL] Hubert, Catherine [UCL]

Management of bile duct injury (BDI) after cholecystectomy is challenging. The authors analyzed their center's 49-year experience. From 1968 to 2016, 120 consecutive patients were managed in a tertiary HBP center, 105 referred from other centers (Group A), 15 from our center (Group B). Surgical strategies and long-term outcomes were retrospectively reviewed. Primary cholecystectomy approach was open in 35% and laparoscopic in 65%. In Group A, intraoperative BDI diagnosis was made in 25/105 patients, including 13 via intraoperative cholangiography (IOC) which was used in 21% of cases. Median time from BDI to referral was 148 days (range 0-10,758), and 3 patients had BDI-related secondary cirrhosis. Ninety-four patients underwent secondary surgical repair, mostly a complex biliary procedure (97%). Postoperative overall and severe morbidity rates were 26% and 6%, respectively. One patient with biliary cirrhosis at referral died postoperatively from hepatic failure. Nine patients (9.6%) developed a secondary biliary stricture after a median of 54 months from repair (6-228 months). In Group B, IOC was performed in 14/15 in whom BDI were intraoperatively detected and immediately repaired. There were 13 minor and 2 major BDIs, all repaired by uncomplex procedures with uneventful postoperative course. One patient had a secondary biliary stricture after 5 months, successfully treated by temporary endoprosthesis. Late follow-up after primary or secondary repair of BDI is recommended to detect recurrent biliary stricture. Bile duct injuries may occur in a tertiary center, but are intraoperatively detected with routine IOC and immediately repaired resulting in satisfactory outcome.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2020
Language Anglais
Journal information "Acta Chirurgica Belgica (Bilingual Edition)" - Vol. 120, no. 2, p. 92-101 (2020)
Peer reviewed yes
Publisher 2016- : London : Taylor & Francis
issn 0001-5458
Publication status Publié
Affiliations UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
UCL - (SLuc) Service de chirurgie et transplantation abdominale
UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie
UCL - (SLuc) Service d'hépato-gastro-entérologie
UCL - SSS/IONS/NEUR - Clinical Neuroscience
UCL - (SLuc) Service de radiologie
UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale
UCL - SSS/IREC - Institut de recherche expérimentale et clinique
Keywords Bile duct injury ; cholecystectomy ; intraoperative cholangiography ; surgical repair
Links
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Bibliographic reference Navez, Julie ; Gigot, Jean-François ; Deprez, Pierre Henri ; Goffette, Pierre ; Annet, Laurence ; et. al. Long-term results of secondary biliary repair for cholecystectomy-related bile duct injury: results of a tertiary referral center.. In: Acta Chirurgica Belgica (Bilingual Edition), Vol. 120, no. 2, p. 92-101 (2020)
Permanent URL http://hdl.handle.net/2078.1/213211