Skip to main content
SpringerLink
Log in

Reoperative Surgery After Repair of Postcholecystectomy Bile Duct Injuries: Is it Worthwhile?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Repeat repair of bile duct injuries (BDIs) after cholecystectomy is technically challenging, and its success remains uncertain. We retrospectively evaluated the short- and long-term outcomes of patients requiring reoperative surgery for BDI at a major referral center for hepatobiliary surgery.

Methods

Between January 1991 and May 2011, we performed surgical BDI repairs in 46 patients. Among them, 22 patients had undergone a previous surgical repair elsewhere (group 1), and 24 patients had no previous repair (group 2). We compared the early and late outcomes in the two groups.

Results

The patients in group 1 were younger (48.6 vs. 54.8 years, p = 0.0001) and were referred after a longer interval (>1 month) from BDI (72.7 vs. 41.7 %, p = 0.042). Intraoperative diagnosis of BDI (59.1 vs. 12.5 %, p = 0.001), ongoing cholangitis (45.4 vs. 12.5 %; p = 0.02), and delay of repair after referral to our institution (116 ± 34 days vs. 23 ± 9 days; p = 0.001) were significantly more frequent in group 1 than in group 2. No significant differences were found for postoperative mortality, morbidity, or length of stay between the groups. Patients with associated vascular injuries had a higher postoperative morbidity rate (p = 0.01) and associated hepatectomy rate (p = 0.045). After a mean follow-up of 96.6 ± 9.7 months (range 5–237.2 months, median 96 months), the rate of recurrent cholangitis (6.5 %) was comparable in the two groups.

Conclusions

This study demonstrates that short- and long-term outcomes after surgical repair of BDI are comparable regardless of whether the patient requires reoperative surgery for a failed primary repair. Associated vascular injuries increase postoperative morbidity and the need for liver resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Savader SJ, Lillemoe KD, Prescott CA et al (1997) Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg 225:268–273

    Article  PubMed  CAS  Google Scholar 

  2. Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg 141:1207–1213

    Article  PubMed  Google Scholar 

  3. Stewart L, Way LW (1995) Bile duct injuries during laparoscopic cholecystectomy: factors that influence the results of treatment. Arch Surg 130:1123–1128 Discussion 1129

    Article  PubMed  CAS  Google Scholar 

  4. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125

    PubMed  CAS  Google Scholar 

  5. Davidoff AM, Pappas TN, Murray EA et al (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215:196–202

    Article  PubMed  CAS  Google Scholar 

  6. Way LW, Stewart L, Gantert W et al (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237:460–469

    PubMed  Google Scholar 

  7. Stewart L, Way LW (2009) Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate—a multivariate analysis of factors influencing surgical outcomes. HPB (Oxford) 11:516–522

    Article  Google Scholar 

  8. Perera MT, Silva MA, Hegab B et al (2011) Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injuries is associated with an improved long-term outcome. Ann Surg 253:553–560

    Article  PubMed  Google Scholar 

  9. Thomson BN, Parks RW, Madhavan KK et al (2006) Early specialist repair of biliary injury. Br J Surg 93:216–220

    Article  PubMed  CAS  Google Scholar 

  10. Schmidt SC, Langrehr JM, Hintze RE et al (2005) Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br J Surg 92:76–82

    Article  PubMed  CAS  Google Scholar 

  11. Sicklick JK, Camp MS, Lillemoe KD et al (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 241:786–792 Discussion 793–795

    Article  PubMed  Google Scholar 

  12. Nuzzo G, Giuliante F, Giovannini I et al (2008) Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy. Am J Surg 195:763–769

    Article  PubMed  Google Scholar 

  13. De Reuver PR, Grossmann I, Busch OR et al (2007) Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury. Ann Surg 245:763–770

    Article  PubMed  Google Scholar 

  14. Pottakkat B, Sikora SS, Kumar A et al (2007) Recurrent bile duct stricture: causes and long-term results of surgical management. J Hepatobiliary Pancreat Surg 14:171–176

    Article  PubMed  Google Scholar 

  15. Chaudhary A, Chandra A, Negi SS et al (2002) Reoperative surgery for postcholecystectomy bile duct injuries. Dig Surg 19:22–27

    Article  PubMed  Google Scholar 

  16. Walsh RM, Vogt DP, Ponsky JL et al (2004) Management of failed biliary repairs for major bile duct injuries after laparoscopic cholecystectomy. J Am Coll Surg 199:192–197

    Article  PubMed  Google Scholar 

  17. Bismuth H, Majno PE (2001) Biliary strictures: classification based on the principles of surgical treatment. World J Surg 25:1241–1244. doi:10.1007/s00268-001-0102-8

    Article  PubMed  CAS  Google Scholar 

  18. Hepp J, Couinaud C (1956) Approach to and use of the left hepatic duct in reparation of the common bile duct. Presse Med 64:947–948

    PubMed  CAS  Google Scholar 

  19. Bachellier P, Nakano H, Weber JC et al (2001) Surgical repair after bile duct and vascular injuries during laparoscopic cholecystectomy: when and how? World J Surg 25:1335–1345. doi:10.1007/s00268-001-0120-6

    Article  PubMed  CAS  Google Scholar 

  20. Li J, Frilling A, Nadalin S et al (2008) Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy. Br J Surg 95:460–465

    Article  PubMed  CAS  Google Scholar 

  21. Jaeck D, Oussoultzoglou E, Rosso E et al (2008) A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240:1037–1049 Discussion 1049–1051

    Article  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  23. Balzan S, Belghiti J, Farges O et al (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 Discussion 828–829

    Article  PubMed  Google Scholar 

  24. Lillemoe KD, Melton GB, Cameron JL et al (2000) Postoperative bile duct strictures: management and outcome in the 1990 s. Ann Surg 232:430–441

    Article  PubMed  CAS  Google Scholar 

  25. Winslow ER, Fialkowski EA, Linehan DC et al (2009) “Sideways”: results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. Ann Surg 249:426–434

    Article  PubMed  Google Scholar 

  26. Browder IW, Dowling JB, Koontz KK et al (1987) Early management of operative injuries of the extrahepatic biliary tract. Ann Surg 205:649–658

    Article  PubMed  CAS  Google Scholar 

  27. Fischer CP, Fahy BN, Aloia TA et al (2009) Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries. HPB (Oxford) 11:32–37

    Article  Google Scholar 

  28. De Reuver PR, Busch OR, Rauws EA et al (2007) Long-term results of a primary end-to-end anastomosis in peroperative detected bile duct injury. J Gastrointest Surg 11:296–302

    Article  PubMed  Google Scholar 

  29. Dumonceau JM, Deviere J, Delhaye M et al (1998) Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst. Gastrointest Endosc 47:8–17

    Article  PubMed  CAS  Google Scholar 

  30. De Palma GD, Persico G, Sottile R et al (2003) Surgery or endoscopy for treatment of postcholecystectomy bile duct strictures? Am J Surg 185:532–535

    Article  PubMed  Google Scholar 

  31. Koffron A, Ferrario M, Parsons W et al (2001) Failed primary management of iatrogenic biliary injury: incidence and significance of concomitant hepatic arterial disruption. Surgery 130:722–728 Discussion 728–731

    Article  PubMed  CAS  Google Scholar 

  32. Schmidt SC, Settmacher U, Langrehr JM et al (2004) Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery 135:613–618

    Article  PubMed  Google Scholar 

  33. Stewart L, Robinson TN, Lee CM et al (2004) Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg 8:523–530 Discussion 530–521

    Article  PubMed  Google Scholar 

  34. Alves A, Farges O, Nicolet J et al (2003) Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg 238:93–96

    PubMed  Google Scholar 

  35. Deziel DJ, Millikan KW, Economou SG et al (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165:9–14

    Article  PubMed  CAS  Google Scholar 

  36. Pulitano C, Parks RW, Ireland H et al (2011) Impact of concomitant arterial injury on the outcome of laparoscopic bile duct injury. Am J Surg 201:238–244

    Article  PubMed  Google Scholar 

  37. Buell JF, Cronin DC, Funaki B et al (2002) Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Arch Surg 137:703–708 Discussion 708–710

    Article  PubMed  Google Scholar 

  38. Bilge O, Bozkiran S, Ozden I et al (2003) The effect of concomitant vascular disruption in patients with iatrogenic biliary injuries. Langenbecks Arch Surg 388:265–269

    Article  PubMed  Google Scholar 

  39. Gupta N, Solomon H, Fairchild R et al (1998) Management and outcome of patients with combined bile duct and hepatic artery injuries. Arch Surg 133:176–181

    Article  PubMed  CAS  Google Scholar 

  40. Laurent A, Sauvanet A, Farges O et al (2008) Major hepatectomy for the treatment of complex bile duct injury. Ann Surg 248:77–83

    Article  PubMed  Google Scholar 

  41. Truant S, Boleslawski E, Lebuffe G et al (2010) Hepatic resection for post-cholecystectomy bile duct injuries: a literature review. HPB (Oxford) 12:334–341

    Google Scholar 

Download references

Acknowledgments

We thank the residents, fellows, and nurses of our division for the care they provided to these patients.

Conflict of interest

The authors have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Moliere, 67098, Strasbourg, France

    Pietro Addeo, Elie Oussoultzoglou, Edoardo Rosso, Cinzia Nobili, Regis Souche, Daniel Jaeck & Philippe Bachellier

  2. Department of Surgical Oncology, The Permanente Medical Group, Walnut Creek, CA, USA

    Pascal Fuchshuber

Authors
  1. Pietro Addeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elie Oussoultzoglou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pascal Fuchshuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edoardo Rosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cinzia Nobili
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Regis Souche
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Jaeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philippe Bachellier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe Bachellier.

Additional information

Pietro Addeo and Elie Oussoultzoglou contributed equally to this study

Rights and permissions

Reprints and permissions

About this article

Cite this article

Addeo, P., Oussoultzoglou, E., Fuchshuber, P. et al. Reoperative Surgery After Repair of Postcholecystectomy Bile Duct Injuries: Is it Worthwhile?. World J Surg 37, 573–581 (2013). https://doi.org/10.1007/s00268-012-1847-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1847-y

Keywords

Search

Navigation