Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy - an E-AHPBA multi-center study.
Journal
HPB : the official journal of the International Hepato Pancreato Biliary Association
ISSN: 1477-2574
Titre abrégé: HPB (Oxford)
Pays: England
ID NLM: 100900921
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
23
12
2018
revised:
18
03
2019
accepted:
01
04
2019
pubmed:
4
6
2019
medline:
15
7
2020
entrez:
2
6
2019
Statut:
ppublish
Résumé
Treatment 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. Members 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. In 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). After 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.
Sections du résumé
BACKGROUND
Treatment 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.
METHODS
Members 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.
RESULTS
In 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).
CONCLUSION
After 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.
Identifiants
pubmed: 31151812
pii: S1365-182X(19)30514-3
doi: 10.1016/j.hpb.2019.04.003
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1641-1647Investigateurs
Jenny M L Rystedt
(JML)
Jörg Kleeff
(J)
Roberto Salvia
(R)
Mark G Besselink
(MG)
Raj Prasad
(R)
Mickael Lesurtel
(M)
Christian Sturesson
(C)
M Abu Hilal
(M)
A Aljaiuossi
(A)
A Antonucci
(A)
F Ardito
(F)
F Ausania
(F)
M Bernon
(M)
F Berrevoet
(F)
B Björnsson
(B)
B A Bonsing
(BA)
E A Boonstra
(EA)
B Bracke
(B)
R Brusadin
(R)
L Burda
(L)
M Caraballo
(M)
M Casellas-Robert
(M)
A Çoker
(A)
J Davide
(J)
A De Gelder
(A)
A M De Rose
(AM)
M Djokic
(M)
K Dudek
(K)
E Ekmekçigil
(E)
M Filauro
(M)
A Fülöp
(A)
T Gallagher
(T)
M Gastaca
(M)
R Gefen
(R)
F Giuliante
(F)
H Habibeh
(H)
J Halle-Smith
(J)
K H Haraldsdottir
(KH)
V Hartman
(V)
A Hauer
(A)
O Hemmingsson
(O)
D Hoskovec
(D)
B Isaksson
(B)
E Jonas
(E)
A Khalaileh
(A)
R Klug
(R)
J Krige
(J)
D Lignier
(D)
J Lindemann
(J)
V López-López
(V)
V Lucidi
(V)
J-Y Mabrut
(JY)
C Månsson
(C)
S Mieog
(S)
D F Mirza
(DF)
K J Oldhafer
(KJ)
J A O Omoshoro-Jones
(JAO)
N Ortega-Torrecilla
(N)
W Otto
(W)
F Panaro
(F)
E Pando
(E)
S Paterna-López
(S)
S Pekmezci
(S)
A Pesce
(A)
R J Porte
(RJ)
I Poves
(I)
M Prieto Calvo
(M)
F Primavesi
(F)
S Puleo
(S)
A Recordare
(A)
M Rizell
(M)
K Roberts
(K)
R Robles-Campos
(R)
E Sanchiz-Cardenas
(E)
P Sandström
(P)
K Saribeyoglu
(K)
M Schauer
(M)
M Schreuder
(M)
A K Siriwardena
(AK)
M D Smith
(MD)
D Sousa Silva
(D)
E Sparrelid
(E)
S Stättner
(S)
G A Stavrou
(GA)
M Straka
(M)
C Strömberg
(C)
R P Sutcliffe
(RP)
A Szijártó
(A)
H Taflin
(H)
B Trotovšek
(B)
T van Gulik
(T)
N Wallach
(N)
K Zieniewicz
(K)
Informations de copyright
Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.