Classification and management of bile duct injuries
2011; Baishideng Publishing Group; Volume: 3; Issue: 4 Linguagem: Inglês
10.4240/wjgs.v3.i4.43
ISSN1948-9366
Autores Tópico(s)Biliary and Gastrointestinal Fistulas
ResumoTo review the classification and general guidelines for treatment of bile duct injury patients and their long term results.In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" hospital in Mexico City and 198 elsewhere (private practice).The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GⅠ-1990-99 (33 cases), G Ⅱ-2000-2004 (139 cases) and GⅢ-2004-2008 (140 cases).All patients were treated with a Roux en Y hepatojejunostomy.A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001).Partial segment Ⅳ and Ⅴ resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis).Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period.The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair.Even interested and tertiary care centers have a learning curve.
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