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Factors associated with patency loss and actuarial patency rate following post-cholecystectomy bile duct injury repair: long-term follow-up

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Abstract

Purpose

Several factors may contribute to bile duct injury (BDI) repair failure. The objective of our study was to evaluate factors that contribute to the loss of patency and influence the actuarial patency rate of BDI repairs in an 11-year period.

Methods

Retrospective review study of patients who underwent a hepaticojejunostomy for a type E Bismuth-Strasberg BDI (2008-2019). The outcomes are the following: primary patency attained, loss of primary patency, and actuarial primary patency rate. Logistic regression for loss of patency and Cox regression for actuarial patency rate were used.

Results

Seventy-nine patients (age 42.3 ± 15.8 years, 81% female) were studied. Most common index operation was open cholecystectomy (60.8%). Most common Bismuth-Strasberg lesion was E4 (38%). Primary patency was 93.4%. Mean follow-up was 36 ± 34 months. Ten-year actuarial patency was 53.9%. Factors associated with loss of patency were vasculobiliary injury, biliary stents, and 90-day biliary complications (univariate); number of surgeries before repair and postoperative cholangitis (univariate and multivariate) (p < 0.05). Factors that impacted actuarial patency rate were (univariate analysis) 90-day biliary complications; postoperative cholangitis and index treatment period stenosis (p < 0.05). No factors impacted actuarial patency rate in multivariate analysis.

Conclusion

Postoperative cholangitis is associated with loss of patency and had potentially detrimental effect on the actuarial patency rate in BDI repair.

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Authors and Affiliations

  1. Organ Transplantation and General Surgery, IMSS UMAE Hospital de Especialidades 14 “Adolfo Ruiz Cortines”, Cuauhtemoc S/N Formando Hogar, 91897, Veracruz, Veracruz, Mexico

    Gustavo Martínez-Mier & Pedro I. Moreno-Ley

  2. Organ Transplantation and General Surgery, SESVER Hospital de Alta Especialidad “Virgilio Uribe” 20 de Noviembre 1074 Centro, 91700, Veracruz, Veracruz, Mexico

    Gustavo Martínez-Mier & Pedro I. Moreno-Ley

  3. Corporativo San Gabriel, Alacio Perez 928-314. Fracc. Zaragoza, 91910, Veracruz, Veracruz, Mexico

    Gustavo Martínez-Mier

  4. General Surgery. IMSS UMAE Hospital de Especialidades 14 “Adolfo Ruiz Cortines”, Cuauhtemoc S/N Formando Hogar, 91897, Veracruz, Veracruz, Mexico

    Daniel Mendez-Rico

Authors
  1. Gustavo Martínez-Mier
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  2. Pedro I. Moreno-Ley
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  3. Daniel Mendez-Rico
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Contributions

Gustavo Martínez-Mier, MD: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript. Pedro I. Moreno-Ley, MD: acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision of manuscript. Daniel Mendez-Rico MD: acquisition of data, analysis and interpretation of data, and critical revision of manuscript.

Corresponding author

Correspondence to Gustavo Martínez-Mier.

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The authors declare that they have no conflict of interest.

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IRB committees (IMSS: R-3001-2015-54 and SESVER: R:18/01/2012).

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Signed by patients.

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Martínez-Mier, G., Moreno-Ley, P.I. & Mendez-Rico, D. Factors associated with patency loss and actuarial patency rate following post-cholecystectomy bile duct injury repair: long-term follow-up. Langenbecks Arch Surg 405, 999–1006 (2020). https://doi.org/10.1007/s00423-020-01984-y

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  • DOI: https://doi.org/10.1007/s00423-020-01984-y

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