Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study
(2019) In HPB 21(12). p.1641-1647- Abstract
- 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... (More)
- 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. © 2019 International Hepato-Pancreato-Biliary Association Inc. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/5f13f01e-6733-4ab5-9db8-630af6834eeb
- author
- Lundmark Rystedt, Jenny LU ; Kleeff, Jorg ; Salvia, Roberto ; Besselink, Mark G ; Prasad, Raj ; Lesurtel, Mickael and Sturesson, Christian
- author collaboration
- organization
- publishing date
- 2019-05-28
- type
- Contribution to journal
- publication status
- published
- subject
- in
- HPB
- volume
- 21
- issue
- 12
- pages
- 1641 - 1647
- publisher
- Elsevier
- external identifiers
-
- scopus:85066124051
- pmid:31151812
- ISSN
- 1477-2574
- DOI
- 10.1016/j.hpb.2019.04.003
- language
- English
- LU publication?
- yes
- additional info
- Export Date: 18 June 2019
- id
- 5f13f01e-6733-4ab5-9db8-630af6834eeb
- date added to LUP
- 2019-06-18 08:34:32
- date last changed
- 2022-04-26 01:35:21
@article{5f13f01e-6733-4ab5-9db8-630af6834eeb,
abstract = {{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. © 2019 International Hepato-Pancreato-Biliary Association Inc.}},
author = {{Lundmark Rystedt, Jenny and Kleeff, Jorg and Salvia, Roberto and Besselink, Mark G and Prasad, Raj and Lesurtel, Mickael and Sturesson, Christian}},
issn = {{1477-2574}},
language = {{eng}},
month = {{05}},
number = {{12}},
pages = {{1641--1647}},
publisher = {{Elsevier}},
series = {{HPB}},
title = {{Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study}},
url = {{http://dx.doi.org/10.1016/j.hpb.2019.04.003}},
doi = {{10.1016/j.hpb.2019.04.003}},
volume = {{21}},
year = {{2019}},
}