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Standardizing Diagnostic and Surgical Approach to Management of Bile Duct Injuries After Cholecystectomy: Long-Term Outcomes of Patients Treated at a High-Volume HPB Center

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Optimal diagnostic and surgical approaches for patients with bile duct injuries (BDI) remain debated. This study reviews results from a standardized approach to management of high-grade BDIs at a North American center.

Design

Patients undergoing surgical repair for BDIs over a 15-year period were included. Post-operative outcomes and biliary patency rates were calculated using imaging, laboratory values, and patient interviews.

Results

A total of 107 consecutive patients underwent repair for BDIs. Bismuth grade I/II injuries were identified in 46 patients (41%), grade III/IV in 41 (38%), grade V in 11 patients (10%), and 9 (10%) were unclassified. BDI anatomy was commonly identified using magnetic resonance imaging (MRI) (75%). Concomitant arterial injuries were identified in 30 (28 with formal angiography). Fifteen had early repairs (within 4 days) and remainder interval repairs (median: 65 days). Hepp-Couinaud repair was method of choice (83%). Estimated primary biliary patency was 100% at 30 days and 87% at 5 years.

Conclusion

With appropriate referral to a specialist, surgical reconstruction of BDIs can have excellent outcomes, even with accompanying arterial injuries. Based on our experience, MR as first imaging modality and supplemental angiography served as the optimal diagnostic strategy. Delayed repair, using Hepp-Couinaud technique, with selective liver resection results in high long-term patency rates.

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Acknowledgements

The authors would like to acknowledge Andy Matlock and Carlos and Davis Center for Surgical Anatomy and Technique at Emory University for the original illustration (Fig. 2).

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Authors and Affiliations

  1. Department of Surgery, Emory University, Atlanta, GA, USA

    Mohammad Raheel Jajja, Syed Omair Nadeem & Juan M. Sarmiento

  2. Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Mohammad Raheel Jajja & Juan M. Sarmiento

  3. School of Medicine, Emory University, Atlanta, GA, USA

    Adrienne Laboe

  4. Department of Surgery, University of Calgary, Calgary, AB, Canada

    Salila Hashmi

  5. University of Toronto, SickKids and Toronto General Hospital, Toronto, ON, Canada

    Blayne Amir Sayed

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  1. Mohammad Raheel Jajja
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Contributions

JMS and MRJ designed and conceived the study. MRJ and BAS wrote initial manuscript. MRJ, SSH, SON, and AL did all data collection. MRJ, SSH, and SON did primary analysis and tabulation of data. MRJ, SSH, AL, SON, JMS, and BAS contributed to manuscript preparation and final approval of manuscript.

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Correspondence to Juan M. Sarmiento.

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Jajja, M.R., Laboe, A., Hashmi, S. et al. Standardizing Diagnostic and Surgical Approach to Management of Bile Duct Injuries After Cholecystectomy: Long-Term Outcomes of Patients Treated at a High-Volume HPB Center. J Gastrointest Surg 25, 2796–2805 (2021). https://doi.org/10.1007/s11605-021-04916-3

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  • DOI: https://doi.org/10.1007/s11605-021-04916-3

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