Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov;25(11):2796-2805.
doi: 10.1007/s11605-021-04916-3. Epub 2021 Feb 2.

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

Mohammad Raheel Jajja  1   2 , Adrienne Laboe  3 , Salila Hashmi  4 , Syed Omair Nadeem  1 , Blayne Amir Sayed  5 , Juan M Sarmiento  6   7
Affiliations

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

Mohammad Raheel Jajja et al. J Gastrointest Surg. 2021 Nov.

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.

Keywords: Bile duct injury; Hepp-Counaid repair; Long-term biliary patency; Vasculobiliary injuries.

PubMed Disclaimer

References

    1. Rystedt J. “E-AHPBA Multicentre Study: Post Cholecystectomy Bile Duct Injury: Early vs Late Repair with Hepaticojejunostomy.” Hpb, vol. 20, 2018, doi: https://doi.org/10.1016/j.hpb.2018.06.276 .
    1. Tornqvist, B., Strömberg C, Persson P, Nilsson M. “Effect of Intended Intraoperative Cholangiography and Early Detection of Bile Duct Injury on Survival after Cholecystectomy: Population Based Cohort Study.” Bmj, vol. 345, no. oct11 1, 2012, doi: https://doi.org/10.1136/bmj.e6457 .
    1. Söderlund C, Frozanpor F, Linderet S. “Bile Duct Injuries at Laparoscopic Cholecystectomy: A Single-Institution Prospective Study. Acute Cholecystitis Indicates an Increased Risk.” World Journal of Surgery, vol. 29, no. 8, 2005, pp. 987–993., doi: https://doi.org/10.1007/s00268-005-7871-4 . - DOI - PubMed
    1. Rystedt J, Lindell G, Montgomery A. “Bile Duct Injuries Associated With 55,134 Cholecystectomies: Treatment and Outcome from a National Perspective.” World Journal of Surgery, vol. 40, no. 1, 2015, pp. 73–80., doi: https://doi.org/10.1007/s00268-015-3281-4 . - DOI
    1. Connor, S, Garden, OJ. “Bile Duct Injury in the Era of Laparoscopic Cholecystectomy.” British Journal of Surgery, vol. 93, no. 2, 2006, pp. 158–168., doi: https://doi.org/10.1002/bjs.5266 . - DOI

LinkOut - more resources