Prognostic implications of preserved bile duct confluence after latrogenic injury

Miguel Ángel Mercado, Carlos Chan, Héctor Orozco, Carlos A. Hinojosa, Eitan Podgaetz, Guillermo Ramos-Gallardo, Raul Gálvez-Treviño, Magdalena Valdés-Villarreal

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations

Abstract

Background/Aims: Biliary reconstruction is performed according to the level of the injury. A comparative study between patients in whom the biliary junction was preserved and another group where the biliary junction was not preserved was done. Methodology: A retrospective review of the biliary reconstructions performed at our institution after iatrogenic lesions between 1990-2002 was done. Postoperative outcome, functional status of the anastomosis, recurrent cholangitis, need for radiological instrumentation and/or reoperation were analyzed. Results: We reviewed 204 cases, 130 cases had a preserved biliary junction while in 74 the injury included the junction. All patients were treated with a Roux-en-Y hepatojejunostomy. In the first group, 4% required reoperation, 4% underwent radiological percutaneous instrumentation, 8% had anastomotic dysfunction and 4% cholangitis. In the second group, 24% needed reoperation and 80% radiological instrumentation. Anastomotic dysfunction was observed in 64% and cholangitis in 55%. It is important to note that 52 of the 74 cases in the second group had a history of more than two reconstruction attempts. Conclusions: When the biliary junction is preserved after a iatrogenic injury we found a significantly better outcome. The results of biliary reconstruction in this type of patient are better long-term compared to those where the junction was not preserved, evidenced by a lower reoperation and radiological instrumentation rate.

Original languageEnglish (US)
Pages (from-to)40-44
Number of pages5
JournalHepato-Gastroenterology
Volume52
Issue number61
StatePublished - Jan 1 2005

Keywords

  • Bile duct injury
  • Hepatojejunostomy
  • Iatrogenic lesion
  • Preserved bile duct junction

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