Original CommunicationTreatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries
Section snippets
Patients and methods
Between January 1996 and March 2008, 44 consecutive patients were treated in our department (Centre Hépato-Biliaire, Paul Brousse Hospital, Assistance Publique des Hopitaux de Paris, Villejuif, France) for the failure of RYHJ performed because of post-cholecystectomy BDI. Our group of patients comprised 13 males (30%) and 31 females (70%) with a mean (± SD) age of 51 ± 14 years (range, 17–78). All BDI were sustained during cholecystectomy performed for cholecystolithiasis. The approach for the
Results
The mean (± SD) follow-up period was 49 ± 40 months (range, 2–153). One patient (2%) died as a result of suicide 44 months after the initial hepatectomy. In 7 patients (16%), ≥2 treatments were required, with a mean follow-up of 33 ± 36 months (range, 2–85). At the time of last follow-up, clinical success had been achieved in 39 patients (89%): 34 patients (77%) were asymptomatic (Terblanche I–II), and 5 patients (11%) had experienced an improvement in their symptoms (Terblanche III). The
Discussion
This study shows that with an experienced multidisciplinary approach (according to the strategy summarized in Fig 3), patients with a failed RYHJ after post-cholecystectomy BDI can achieve good long-term clinical success in 89%. These results required more than the first-line revision in 16% of patients. Although we showed that waiting for bile duct dilation before revisionary surgery was not successful; moreover, we were unable to identify any prognostic predictive factor at referral in our
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Cited by (24)
Factors leading to loss of patency after biliary reconstruction of major laparoscopic cholecystectomy bile duct injuries: an observational study with long-term outcomes
2020, HPBCitation Excerpt :In addition, several proposed modifiable contributing factors have been identified, including incomplete imaging of the biliary tree before index reconstruction,4,5 choice of surgical technique,6,7 initial reconstruction by a non-specialized hepato-pancreato-biliary (HPB) surgeon,8 early index reconstruction4,8 and late referral to an HPB specialist.8,9 Very few studies have evaluated BDI patients who require a revision of the initial reconstruction as the primary study population.4,6,7,10–12 These studies have small cohorts and the conclusions are not consistent across reports.
Bile duct injury repairs: Progressive outcomes in a tertiary referral center
2019, Surgery (United States)Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study
2018, Annals of Medicine and SurgeryCitation Excerpt :Nevertheless, symptomatic patients with associated vascular lesions, lobar parenchyma atrophy, or abscesses benefit from hepatectomy [2,33–35]. There is little literature on the long-term outcomes after surgical reconstruction of MBDIs, moreover, the factors predicting those outcomes have not been studied extensively [14,30,36–38]. Our study aimed to analyze the early and late outcomes of surgical management of LC- related MBDIs in a tertiary referral center.
Portal biliopathy as a complication of extrahepatic portal hypertension: Etiology, presentation and management
2015, Journal de Chirurgie Viscerale