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Biliary cirrhosis and sepsis are two risk factors of failure after surgical repair of major bile duct injury post-laparoscopic cholecystectomy

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Abstract

Background

Major bile duct injury (MBDI) remains frequent after laparoscopic cholecystectomy (LC) reaching 0.3 to 0.6 % and is associated with a significant mortality rate. The aim of this study was to retrospectively analyze the factors likely to influence the long-term results of surgical repair for MBDI occurring after LC.

Methods

Medical records of patients referred to our referral center from January 1992 to January 2010 for management of bile duct injury following LC were retrospectively analyzed, and patients with MBDI were identified. Clinicopathological factors likely to influence long-term results after surgical repair were assessed by univariate and multivariable analysis.

Results

During the study period, 38 patients were treated for MBDI. These 38 patients underwent Roux-en-Y hepaticojejunostomy (HJ) or HJ revision in 25 (66 %) and 13 (34 %) cases, respectively. The median follow-up period was 93 (26–204) months. A Clavien-Dindo post-operative morbidity class >3 occurred in 10 (26 %) cases and was independently associated with a surgical repair performed during a sepsis period (OR = 102.5; IC 95 % [7.12; 11,352], p < 0.007). Long-term results showed that biliary strictures occurred in 5 (13 %) cases and were associated with sepsis (p < 0.006), liver cirrhosis (p < 0.002) and post-operative complications (p < 0.012). Multivariate analysis revealed that only liver cirrhosis remained predictive of stricture (OR = 26.4, 95 % CI [2; 1,018], p < 0.026).

Conclusion

When MBDI occurs following LC, HJ seems to be the optimal treatment but should not be performed during a sepsis period. Long-term results are significantly altered by the presence of a biliary cirrhosis at time of repair.

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Conflicts of interest

The authors have no conflicts of interest to declare.

Funding

The study received no external support.

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Authors and Affiliations

  1. Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France

    L. Sulpice, S. Garnier, M. Rayar, B. Meunier & K. Boudjema

  2. INSERM, UMR 991, Foie, métabolisme et cancer, Université de Rennes 1, Rennes, France

    L. Sulpice & K. Boudjema

Authors
  1. L. Sulpice
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  2. S. Garnier
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  3. M. Rayar
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  4. B. Meunier
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  5. K. Boudjema
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Corresponding authors

Correspondence to L. Sulpice or K. Boudjema.

Additional information

This work was presented as an oral communication to the 115th Congress of French Association of Surgery, Paris, September 2013

L. Sulpice and S. Garnier have equally participated in this article.

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Sulpice, L., Garnier, S., Rayar, M. et al. Biliary cirrhosis and sepsis are two risk factors of failure after surgical repair of major bile duct injury post-laparoscopic cholecystectomy. Langenbecks Arch Surg 399, 601–608 (2014). https://doi.org/10.1007/s00423-014-1205-7

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  • DOI: https://doi.org/10.1007/s00423-014-1205-7

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