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Surgical management of post-cholecystectomy bile duct injuries: referral patterns and factors influencing early and long-term outcome

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Abstract

Cholecystectomy-related bile duct injuries (BDI) remain a cause of significant morbidity and debate concerning optimal management is ongoing. We reviewed our experience with surgical management of BDI to assess patterns of referral along with postoperative and long-term outcomes. During September 1996–August 2013, 35 patients were operated in our tertiary care center for a Bismuth-Strasberg grade >A BDI after a cholecystectomy performed elsewhere. Injury grade distribution was as follows: D, n = 3; E1, n = 4; E2, n = 15; E3, n = 5; E4, n = 5; E5, n = 3. Four patients (11.4 %) had an associated vascular injury (arterial, n = 2; portal, n = 1; both, n = 1). Treatment was direct repair + Kehr drain placement (n = 1), hepaticojejunostomy (n = 28), hepaticojejunostomy + hepatic resection (n = 5), and liver transplantation (n = 1). There was one postoperative death (2.8 %) due to hepatic failure after liver resection; severe (Dindo-Clavien grade ≥3b) complications were observed in 12 (34.3 %) patients. Sepsis at referral (OR 17.33, p = 0.007) and laparotomy prior to definitive repair (OR 14, p = 0.04) were the factors associated with severe complications. Median follow-up was 81 (range 12–182) months; two patients were lost to follow-up. Treatment failure (defined as need for reoperation or interventional radiology procedure during follow-up) was observed in 7/32 (21.9 %) patients. No association between baseline variables and treatment failure was observed. Post-cholecystectomy BDI represent a heterogeneous entity. The whole armamentarium of the hepatobiliary surgeon is required to achieve proper management. Patients referred with sepsis and requiring laparotomy prior to definitive repair are more prone to develop severe complications.

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Conflict of interest

The authors declare that they have nothing to disclose.

Statement of human and animal rights

All procedures performed in the study were in accordance with the ethical standards of our Institutional Research Committee and of the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants in the study prior to their biliary repair operation.

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Authors and Affiliations

  1. General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Corso Bramante 88 – 90, 10126, Turin, Italy

    Damiano Patrono, Rosa Benvenga, Fabio Colli, Paolo Baroffio, Renato Romagnoli & Mauro Salizzoni

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  1. Damiano Patrono
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  2. Rosa Benvenga
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  3. Fabio Colli
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  4. Paolo Baroffio
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  5. Renato Romagnoli
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  6. Mauro Salizzoni
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Correspondence to Renato Romagnoli.

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Patrono, D., Benvenga, R., Colli, F. et al. Surgical management of post-cholecystectomy bile duct injuries: referral patterns and factors influencing early and long-term outcome. Updates Surg 67, 283–291 (2015). https://doi.org/10.1007/s13304-015-0311-6

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  • DOI: https://doi.org/10.1007/s13304-015-0311-6

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