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Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study

2019; Elsevier BV; Volume: 21; Issue: 12 Linguagem: Inglês

10.1016/j.hpb.2019.04.003

1477-2574

Jenny Rystedt, Jörg Kleeff, Roberto Salvia, Marc G. Besselink, Rajendra Prasad, Mickaël Lesurtel, Christian Sturesson, Mohammad Abu Hilal, Anas Aljaiuossi, A Antonucci, Francesco Ardito, Francesco Ausania, M. Bernon, Frederik Berrevoet, Bergþór Björnsson, Bert A. Bonsing, Elizabeth A. Boonstra, B. Bracke, Roberto Brusadín, L Burda, M. Caraballo, Margarida Casellas‐Robert, Ahmet Çöker, José Davide, Anouk De Gelder, Agostino Maria De Rose, Mihajlo Djokić, Krzysztof Dudek, Ela Ekmekcigil, Marco Filauro, András Fülöp, Tom Gallagher, Mikel Gastaca, Rachel Gefen, Felice Giuliante, Hussein Habibeh, James Halle‐Smith, Kristín Haraldsdóttir, V. Hartman, Alexandra Hauer, Oskar Hemmingsson, David Hoskovec, B. Isaksson, Eduard Jonas, Aved Khalaileh, R. Klug, J E J Krige, Delphine Lignier, Jessica Lindemann, Víctor López‐López, Valério Lucidi, Jean‐Yves Mabrut, C. Månsson, S. Mieog, D. F. Mirza, Karl J. Oldhafer, J. Omoshoro–Jones, Nuria Ortega Torrecilla, W. Otto, Fabrizio Panaro, Elizabeth Pando, Sandra Paterna-López, Salih Pekmezci, Antonio Pesce, Robert J. Porte, Ignasi Poves, Mikel Prieto, Florian Primavesi, Stefano Puleo, Alfonso Recordare, Magnus Rizell, Keith Roberts, R Robles, E. Sanchiz-Cardenas, Per Sandström, Kaya Sarıbeyoğlu, Matthias Schauer, Michiel F. Schreuder, Ajith K. Siriwardena, Martin Smith, Donzília Sousa Silva, Ernesto Sparrelid, Stefan Stättner, Gregor A. Stavrou, Matús Straka, C. Strömberg, Robert P. Sutcliffe, Attila Szíjártó, Helena Taflin, Blaž Trotovšek, TM van Gulik, Nadav Wallach, Krzysztof Zieniewicz,

Pediatric Hepatobiliary Diseases and Treatments

BackgroundTreatment of bile duct injuries (BDI) during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy.MethodsMembers of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0–7), intermediate (1–6 weeks) and late (6 weeks–6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality.ResultsIn total 913 patients from 48 centers were included in the analysis. In 401 patients (44%) the bile duct injury was diagnosed intraoperatively, and 126 patients (14%) suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37–8.65; p = 0.009).ConclusionAfter BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable.