Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study
2019
Rystedt, Jenny M.L. | Kleeff, Jörg | Salvia, Roberto | Besselink, Mark | Prasad, Raj | Lesurtel, Mickael | Sturesson, Christian | Abu Hilal, M. | Aljaiuossi, A. | Antonucci, A. | Ardito, F. | Ausania, F. | Bernon, M. | Berrevoet, F. | Bjornsson, B. | Bonsing, B.A. | Boonstra, E.A. | Bracke, B. | Brusadin, R. | Burda, L. | Caraballo, M. | Casellas-Robert, M. | Çoker, A. | Davide, J. | de Gelder, A. | de Rose, A.M. | Djokic, M. | Dudek, K. | Ekmekçigil, E. | Filauro, M. | Fülöp, A. | Gallagher, T. | Gastaca, M. | Gefen, R. | Giuliante, F. | Habibeh, H. | Halle-Smith, J. | Haraldsdottir, K.H. | Hartman, V. | Hauer, A. | Hemmingsson, O. | Hoskovec, D. | Isaksson, B. | Jonas, E. | Khalaileh, A. | Klug, R. | Krige, J. | Lignier, Delphine | Lindemann, J. | López-López, V. | Lucidi, V. | Mabrut, J.-Y. | Månsson, C. | Mieog, S. | Mirza, D.F. | Oldhafer, K.J. | Omoshoro-Jones, J.A.O. | Ortega-Torrecilla, N. | Otto, W. | Panaro, F. | Pando, E. | Paterna-López, S. | Pekmezci, S. | Pesce, A. | Porte, R.J. | Poves, I. | Prieto Calvo, M. | Primavesi, F. | Puleo, S. | Recordare, A. | Rizell, M. | Roberts, K. | Robles-Campos, R. | Sanchiz-Cardenas, E. | Sandström, P. | Saribeyoglu, K. | Schauer, M. | Schreuder, M. | Siriwardena, A.K. | Smith, M.D. | Sousa Silva, D. | Sparrelid, E. | Stättner, S. | Stavrou, G.A. | Straka, M. | Strömberg, C. | Sutcliffe, R.P. | Szijártó, A. | Taflin, H. | Trotovšek, B. | van Gulik, T. | Wallach, N. | Zieniewicz, K. | Skane University Hospital [Lund] | Fachbereich Physik [Halle-Saale] ; Martin-Luther-Universität Halle Wittenberg - Martin-Luther-University Halle Wittenberg (MLU) | Azienda Ospedaliera Universitaria Integrata of Verona | Universiteit van Amsterdam = University of Amsterdam (UvA) | St James's University Hospital ; Leeds Teaching Hospitals NHS Trust | Hôpital de la Croix-Rousse [CHU - HCL] ; Hospices Civils de Lyon (HCL) | Karolinska University Hospital [Stockholm] | University of Southampton | Policlinico di Monza ; Partenaires INRAE | Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome] (UNIROMA) | Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt) | Complexo Hospitalario Universitario de Vigo ; Partenaires INRAE | Ghent University Hospital | Linköping University (LIU) | Universiteit Leiden = Leiden University | University Medical Center Groningen [Groningen] (UMCG) | Universiteit Antwerpen = University of Antwerpen [Antwerpen] | Universidad de Murcia | J. G. Mendel Cancer Center Novy Jicin | Universidad de Salamanca [España] = University of Salamanca [Spain] | Hospital Dr Josep Trueta de Girona | Izmir University, TURKEY | Faculdade de Medicina da Universidade do Porto (FMUP) ; Universidade do Porto = University of Porto | University of Ljubljana | Uniwersytet Warszawski [Polska] = University of Warsaw [Poland] = Université de Varsovie [Pologne] (UW) | İZMİR EGE University Medical Faculty Hospital ; Partenaires INRAE | Università degli studi di Genova = University of Genoa (UniGe) | Semmelweis University of Medicine [Budapest] | University of Dublin | Universidad de Deusto (DEUSTO) | Hospital Universitario Cruces = Cruces University Hospital | Hadassah Hebrew University Hospital ; The Hebrew University of Jerusalem (HUJ) | Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) | Queens Elizabeth Hospital [Birmingham] | University of Iceland [Reykjavik] | Community Hospital of horn | Umeå University = Umeå Universitet | University Hospital Motol [Prague] | Uppsala Universitet [Uppsala] | University of Cape Town | Hadassah Hebrew University Medical Center [Jerusalem] | Community Hospital Horn | CHU Amiens-Picardie | Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC) ; Université de Picardie Jules Verne (UPJV) | Vrije Universiteit Brussel [Bruxelles] (VUB) | Université de Lyon | Asklepios Klinik Barmbek | University of Johannesburg [South Africa] (UJ) | Vall d'Hebron University Hospital [Barcelona] | Facultad de Medicina [Zaragoza] ; Universidad de Zaragoza = University of Zaragoza [Saragossa University] = Université de Saragosse | Cerrahpasa Medical Faculty | Università degli studi di Catania = University of Catania (Unict) | IMIM-Hospital del Mar ; Generalitat de Catalunya = Generalidad de Cataluña = Government of Catalonia = Généralité de Catalogne | Innsbruck Medical University = Medizinische Universität Innsbruck (IMU) | Unité Expérimentale Recherches Intégrées - Gotheron (UERI) ; Institut National de la Recherche Agronomique (INRA) | University of Pristina-Kosovo | Peja/Pec Hospital | Sahlgrenska Academy at University of Gothenburg [Göteborg] ; Göteborgs Universitet = University of Gothenburg (GU) | Universidad de Málaga [Málaga] = University of Málaga [Málaga] | University Hospital Düsseldorf | Vrije Universiteit Medical Centre (VUMC) ; Vrije Universiteit Amsterdam [Amsterdam] (VU) | Manchester Royal Infirmary ; University of Manchester [Manchester] | Chris Hani Baragwanath Hospital [Johannesburg, South Africa] (CHBH) | Asklepios Klinik Barmbek | Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS) ; Hospices Civils de Lyon (HCL)
International audience
Show more [+] Less [-]English. 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.
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