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Waiting for bile duct dilation before repair of bile duct injury: a worthwhile strategy?

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Abstract

Background

Hepaticojejunostomy (HJ) is the gold standard procedure for repairing major bile duct injury (BDI). Dilation status of the BD before repair has not been assessed as a risk factor for anastomotic stricture.

Method

This retrospective single-centre study was performed on a population of 87 patients with BDI repaired by HJ between 2007 and 2021. Dilation status was assessed preoperatively, and dilation was defined as the presence of visible peripheral intrahepatic BDs with remaining BD diameter > 8 mm. The short- and long-term outcomes of HJ were assessed according to preoperative dilation status.

Results

Before final repair, the BDs were dilated (dBD) in 56.3% of patients and not dilated (ND) in 43.7%. Patients with ND at the time of repair had more severe BDI injury than those with dBD (94.7% vs. 77.6%, p = 0.026). The rate of preoperative cholangitis was lower in patients with ND than in those with dBD (10.5% vs. 44.9%, p = 0.001). The rate of short-term morbidity after HJ was 33.3% (ND vs. dBD: 38.8% vs. 26.3%, p = 0.32). Long-term anastomotic stricture rate was 5.7% with a mean follow-up period of 61.3 months. There were no differences in long-term biliary complications according to dilation status (ND vs. dBD: 12.2% vs. 10.5%, p = 1).

Conclusion

Dilation status of the BD before HJ for BDI seemed to have no impact on short- or long-term outcomes. Both surgical and radiological external biliary drainages after BDI appear to be acceptable options to reduce cholangitis before repair without increasing risk for long-term anastomotic stricture.

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Data availability

Data are in possession of the corresponding author.

Abbreviations

ASA:

American Society of Anesthesiologists

BDI:

Bile duct injury

CT:

Computed tomography

HJ:

Hepaticojejunostomy

MRI:

Magnetic resonance imaging

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Acknowledgements

The authors would like to thank Ms. E. Faherty for checking the English in this manuscript. The English in this document has been also checked by at least two professional editors, both native speakers of English. For a certificate, please see http://www.textcheck.com/certificate/MG4clM

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Authors and Affiliations

  1. Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France

    Arthur Marichez, Benjamin Fernandez, Paul Mauriac, Céline Julien, Jean-Philippe Adam, Christophe Laurent & Laurence Chiche

  2. Inserm UMR 1312 – Team 3 “Liver Cancers and Tumoral Invasion”, Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France

    Arthur Marichez & Laurence Chiche

  3. Inserm, Bordeaux Population Health Research Center, ISPED, Bordeaux, France

    Yaniss Belaroussi

  4. Digestive Endoscopy Unit, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France

    Clément Subtil

  5. Department of Digestive Interventional Radiology, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France

    Bruno Lapuyade

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  1. Arthur Marichez
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Contributions

Substantial contributions to the conception: AM, BF, YB, and LC. Design of the work: JPA, CL, and LC. Acquisition, analysis, or interpretation of data for the work: AM, PM, JC, CS, and BL. Drafting the work: AM, BF, YB, and LC. Revising it critically for important intellectual content: PM, JC, CS, BL, JPA, and CL. Final approval of the version to be published: AM, BF, YB, PM, JC, CS, BL, JPA, CL, and LC. Agreement to be accountable for all aspects of the work: AM, BF, YB, PM, JC, CS, BL, JPA, CL, and LC.

Corresponding author

Correspondence to Arthur Marichez.

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This study was presented at the 18th Congress of the French Association de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Paris, France, as an oral communication and at the 15th Biennial Congress of the European-African Hepato-Pancreato-Biliary Association, Lyon, France, as a poster.

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Marichez, A., Fernandez, B., Belaroussi, Y. et al. Waiting for bile duct dilation before repair of bile duct injury: a worthwhile strategy?. Langenbecks Arch Surg 408, 409 (2023). https://doi.org/10.1007/s00423-023-03139-1

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