Skip to main content
SpringerLink
Log in

Minimally invasive biliary anastomosis after iatrogenic bile duct injury: a systematic review

  • Review Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Major bile duct injuries (BDIs) may require complex surgical repairs that are usually performed with a conventional open approach. This study aims to analyze current evidence concerning the safety and the outcomes of the minimally invasive (MI) approach for biliary anastomosis in post-cholecystectomy BDIs. A systematic search of MEDLINE, Embase, and Web-Of-Science indexed studies involving MI (laparoscopic or robotic) biliary anastomosis in patients with iatrogenic BDIs was performed. The quality of the studies was assessed using the MINORS criteria. A total of 13 studies involving 198 patients were included. One hundred and twenty-five patients (63.1%) underwent a laparoscopic biliary anastomosis, while 73 (36.1%) received an analogue robotic procedure. All the included BDIs were types D and E (E1–E5). The mean OT varied between 190 and 330 (mean = 227) minutes. Ten studies reported the mean intraoperative blood loss that ranged between 50 and 252 (mean = 135.9) mL. No conversions occurred in the robotic series, while four patients required conversion to open surgery among the laparoscopic ones. The mean length of postoperative hospital stay was 6.3 days. The reported overall morbidity was similar among the robotic and laparoscopic series. During the follow‐up period, no surgery-related mortality occurred. A growing number of referral centers are showing the safety and feasibility of the MI approach for biliary anastomosis in patients with major BDIs. Further prospective comparative studies are needed to draw more definitive conclusions.

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. Alexander HC, Bartlett AS, Wells CI et al (2018) Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB 20(9):786–794. https://doi.org/10.1016/j.hpb.2018.03.004

    Article  Google Scholar 

  2. Hogan NM, Dorcaratto D, Hogan AM et al (2016) Iatrogenic common bile duct injuries: Increasing complexity in the laparoscopic era: A prospective cohort study. Int J Surg 33:151–156. https://doi.org/10.1016/j.ijsu.2016.08.004

    Article  Google Scholar 

  3. Fletcher R, Cortina CS, Kornfield H et al (2020) Bile duct injuries: a contemporary survey of surgeon attitudes and experiences. Surg Endosc 34(7):3079–3084. https://doi.org/10.1007/s00464-019-07056-7

    Article  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(1):101–125

    CAS  Google Scholar 

  5. Schreuder AM, Busch OR, Besselink MG et al (2020) Long-term impact of iatrogenic bile duct injury. Dig Surg 37(1):10–21. https://doi.org/10.1159/000496432

    Article  Google Scholar 

  6. Booij KAC, de Reuver PR, van Dieren S et al (2018) Long-term impact of bile duct injury on morbidity, mortality, quality of life, and work related limitations. Ann Surg 268(1):143–150. https://doi.org/10.1097/SLA.0000000000002258

    Article  Google Scholar 

  7. Koppatz H, Sallinen V, Mäkisalo H, Nordin A (2021) Outcomes and quality of life after major bile duct injury in long-term follow-up. Surg Endosc 35(6):2879–2888. https://doi.org/10.1007/s00464-020-07726-x

    Article  Google Scholar 

  8. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies ( MINORS ): development and validation of a new instrument: Methodological index for non-randomized studies. ANZ J Surg 73(9):712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  Google Scholar 

  9. Crema E, Silva AA, Lenza RM, de Oliveira CB, Bridi VAU, Martins A (2002) Excluded-loop hepatojejunal anastomosis with use of laparoscopy in late management of iatrogenic ligature of the bile duct. Surg Laparosc Endosc Percutan Tech 12(2):110–114. https://doi.org/10.1097/00129689-200204000-00007

    Article  Google Scholar 

  10. Palermo M, Trelles N, Gagner M (2011) Laparoscopic revisional hepaticojejunostomy for biliary stricture after open repair following common bile duct injury: a case report. Surg Innov 18(1):105–109. https://doi.org/10.1177/1553350610395033

    Article  Google Scholar 

  11. Prasad A (2015) Robotic assisted Roux-en-Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury. WJG 21(6):1703. https://doi.org/10.3748/wjg.v21.i6.1703

    Article  Google Scholar 

  12. Ayloo S, Schwartzman J (2019) Robot-assisted repair of E1 biliary ductal injury with Roux-en-Y hepaticojejunostomy. J Laparoendosc Adv Surg Tech A 29(6):817–819. https://doi.org/10.1089/lap.2018.0664

    Article  Google Scholar 

  13. Machado MA, Surjan RC, Ardengh AO, Makdissi F (2019) Robotic left hepatectomy and Roux-en-Y hepaticojejunostomy after bile duct injury. Ann Surg Oncol 26(9):2981–2984. https://doi.org/10.1245/s10434-019-07474-w

    Article  Google Scholar 

  14. Goméz D, Cabrera LF, Pedraza-Ciro M, Mendoza A, Pulido J (2020) Laparoscopic Roux-en-Y hepaticojejunostomy reconstruction after iatrogenic bile duct injury: case series report. Cir Cir 88(5):608–616. https://doi.org/10.24875/CIRU.20001541

    Article  Google Scholar 

  15. Marino MV, Mirabella A, Guarrasi D, Lupo M, Komorowski AL (2019) Robotic-assisted repair of iatrogenic common bile duct injury after laparoscopic cholecystectomy: Surgical technique and outcomes. Int J Med Robot 15(3):e1992. https://doi.org/10.1002/rcs.1992

    Article  Google Scholar 

  16. Sucandy I, Jabbar F, Syblis C et al (2022) Robotic versus open extrahepatic biliary reconstruction for iatrogenic bile duct injury. Am Surg 88(3):345–347. https://doi.org/10.1177/00031348211047472

    Article  Google Scholar 

  17. Kwak BJ, Choi HJ, You YK, Kim DG, Hong TH (2019) Laparoscopic end-to-end biliary reconstruction with T-tube for transected bile duct injury during laparoscopic cholecystectomy. Ann Surg Treat Res 96(6):319. https://doi.org/10.4174/astr.2019.96.6.319

    Article  Google Scholar 

  18. Javed A, Shashikiran BD, Aravinda PS, Agarwal AK (2021) Laparoscopic versus open surgery for the management of post-cholecystectomy benign biliary strictures. Surg Endosc 35(3):1254–1263. https://doi.org/10.1007/s00464-020-07496-6

    Article  Google Scholar 

  19. D’Hondt M, Wicherts DA (2022) Robotic biliary surgery for benign and malignant bile duct obstruction: a case series. J Robotic Surg. https://doi.org/10.1007/s11701-022-01392-y

    Article  Google Scholar 

  20. Giulianotti PC, Quadri P, Durgam S, Bianco FM (2018) Reconstruction/repair of iatrogenic biliary injuries: is the robot offering a new option? short clinical report. Annals Surg 267(1):e7–e9. https://doi.org/10.1097/SLA.0000000000002343

    Article  Google Scholar 

  21. Chowbey PK, Soni V, Sharma A, Khullar R, Baijal M (2005) Laparoscopic hepaticojejunostomy for biliary strictures: the experience of 10 patients. Surg Endosc 19(2):273–279. https://doi.org/10.1007/s00464-003-8288-5

    Article  CAS  Google Scholar 

  22. Chen D, Zhu A, Zhang Z (2013) Total laparoscopic Roux-en-Y cholangiojejunostomy for the treatment of biliary disease. JSLS 17(2):178–187. https://doi.org/10.4293/108680813X13654754535232

    Article  Google Scholar 

  23. Dokmak S, Amharar N, Aussilhou B et al (2017) Laparoscopic repair of post-cholecystectomy bile duct injury: an advance in surgical management. J Gastrointest Surg 21(8):1368–1372. https://doi.org/10.1007/s11605-017-3400-7

    Article  Google Scholar 

  24. Cuendis-Velázquez A, Trejo-Ávila M, Bada-Yllán O et al (2019) A new era of bile duct repair: robotic-assisted versus laparoscopic hepaticojejunostomy. J Gastrointest Surg 23(3):451–459. https://doi.org/10.1007/s11605-018-4018-0

    Article  Google Scholar 

  25. Sahoo MR, Ali MS, Sarthak S, Nayak J (2022) Laparoscopic hepaticojejunostomy for benign biliary stricture: A case series of 16 patients at a tertiary care centre in India. J Minim Access Surg 18(1):20–24. https://doi.org/10.4103/jmas.JMAS_223_20

    Article  Google Scholar 

  26. Wang X, Yu WL, Fu XH, Zhu B, Zhao T, Zhang YJ (2020) Early versus delayed surgical repair and referral for patients with bile duct injury: a systematic review and meta-analysis. Ann Surg 271(3):449–459. https://doi.org/10.1097/SLA.0000000000003448

    Article  Google Scholar 

  27. Perera MTPR, 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(3):553–560. https://doi.org/10.1097/SLA.0b013e318208fad3

    Article  Google Scholar 

  28. Guerra F, Coletta D, Gavioli M, Coco D, Patriti A (2020) Minimally invasive surgery for the management of major bile duct injury due to cholecystectomy. J Hepatobiliary Pancreat Sci 27(4):157–163. https://doi.org/10.1002/jhbp.710

    Article  Google Scholar 

  29. Ismael HN, Cox S, Cooper A, Narula N, Aloia T (2017) The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB 19(4):352–358. https://doi.org/10.1016/j.hpb.2016.12.004

    Article  Google Scholar 

  30. Boerma D, Rauws EAJ, Keulemans YCA et al (2001) Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg 234(6):750–757. https://doi.org/10.1097/00000658-200112000-00006

    Article  CAS  Google Scholar 

  31. Walsh RM, Henderson JM, Vogt DP, Brown N (2007) Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 142(4):450–457. https://doi.org/10.1016/j.surg.2007.07.008

    Article  Google Scholar 

  32. Pitt HA, Sherman S, Johnson MS et al (2013) Improved outcomes of bile duct injuries in the 21st century. Ann Surg 258(3):490–499. https://doi.org/10.1097/SLA.0b013e3182a1b25b

    Article  Google Scholar 

  33. Dimou FM, Adhikari D, Mehta HB, Olino K, Riall TS, Brown KM (2016) Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery 160(3):691–698. https://doi.org/10.1016/j.surg.2016.05.021

    Article  Google Scholar 

  34. Dageforde LA, Landman MP, Feurer ID, Poulose B, Pinson CW, Moore DE (2012) A cost-effectiveness analysis of early vs late reconstruction of iatrogenic bile duct injuries. J Am Coll Surg 214(6):919–927. https://doi.org/10.1016/j.jamcollsurg.2012.01.054

    Article  Google Scholar 

  35. Thomson BNJ, Parks RW, Madhavan KK, Wigmore SJ, Garden OJ (2006) Early specialist repair of biliary injury. Br J Surg 93(2):216–220. https://doi.org/10.1002/bjs.5194

    Article  CAS  Google Scholar 

  36. Huang Q, Yao HH, Shao F et al (2014) Analysis of risk factors for postoperative complication of repair of bile duct injury after laparoscopic cholecystectomy. Dig Dis Sci 59(12):3085–3091. https://doi.org/10.1007/s10620-014-3255-7

    Article  Google Scholar 

  37. Lindemann J, Jonas E, Kotze U, Krige JEJ (2020) Evolution of bile duct repair in a low and middle-income country (LMIC): a comparison of diagnosis, referral, management and outcomes in repair of bile duct injury after laparoscopic cholecystectomy from 1991 to 2004 and 2005–2017. HPB 22(3):391–397. https://doi.org/10.1016/j.hpb.2019.07.009

    Article  Google Scholar 

  38. Krige JE (2010) Bile leaks and sepsis: drain now, fix later: comment on “bile duct injuries associated with laparoscopic cholecystectomy.” Arch Surg 145(8):763. https://doi.org/10.1001/archsurg.2010.154

    Article  Google Scholar 

  39. Rystedt JML, Kleeff J, Salvia R et al (2019) Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study. HPB 21(12):1641–1647. https://doi.org/10.1016/j.hpb.2019.04.003

    Article  Google Scholar 

  40. Pulitanò C, Parks RW, Ireland H, Wigmore SJ, Garden OJ (2011) Impact of concomitant arterial injury on the outcome of laparoscopic bile duct injury. Am J Surg 201(2):238–244. https://doi.org/10.1016/j.amjsurg.2009.07.038

    Article  Google Scholar 

  41. Alves A, Farges O, Nicolet J, Watrin T, Sauvanet A, Belghiti J (2003) Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg 238(1):93–96. https://doi.org/10.1097/01.sla.0000074983.39297.c5

    Article  Google Scholar 

  42. Strasberg SM, Helton WS (2011) An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB 13(1):1–14. https://doi.org/10.1111/j.1477-2574.2010.00225.x

    Article  Google Scholar 

Download references

Funding

The authors received no specific funding for this work.

Author information

Authors and Affiliations

  1. Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA

    Antonio Cubisino, Nicolas H. Dreifuss & Francesco M. Bianco

  2. Department of Clinical Medicine and Surgery, Minimally Invasive and Robotic HPB Surgery Unit, Federico II University, Naples, Italy

    Gianluca Cassese

  3. Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France

    Fabrizio Panaro

Authors
  1. Antonio Cubisino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas H. Dreifuss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianluca Cassese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco M. Bianco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabrizio Panaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each individual listed as an author on this article contributed substantially and in accordance with the guidelines of the International Committee of Medical Journal Editors.

Corresponding author

Correspondence to Antonio Cubisino.

Ethics declarations

Conflict of interests

AC, NHD, GC and FP have no conflict of interest or financial ties to disclose. FMB has an educational agreement with Asensus, Intuitive, and Medtronic.

Ethical standards

Research involving human participants and/or animals.

This research did not involve human participants and/or animals, since it is a secondary research.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cubisino, A., Dreifuss, N.H., Cassese, G. et al. Minimally invasive biliary anastomosis after iatrogenic bile duct injury: a systematic review. Updates Surg 75, 31–39 (2023). https://doi.org/10.1007/s13304-022-01392-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-022-01392-5

Keywords

Search

Navigation