Iatrogenic biliary tract lesions requiring surgical reconstruction – presentation and classification of the lesions, their reconstruction and evaluation of the results
Authors:
M. Straka 1,2,5; E. Holášková 1,2; L. Burda 1,2; M. Vávrová 3; P. Fojtík 4; M. Škrovina 1,2,5
Authors‘ workplace:
Chirurgické oddělení Nemocnice Nový Jičín
primár: MUDr. M. Škrovina, Ph. D.
1; Komplexní onkologické centrum Nemocnice Nový Jičín
primár: doc. MUDr. R. Soumarová, Ph. D., MBA
2; Oddelení radiologie a zobrazovacích metod Nemocnice Nový Jičín
primár: MUDr. M. Velkoborský
3; Centrum péče o zažívací trakt Vítkovická Nemocnice
vedúci pracoviska: MUDr. O. Urban, Ph. D.
4; Vzdělávací a výzkumný institut AGEL o. p. s., Prostějov
vedúci pracoviska: Ing. Mgr. K. Murtingerová
5
Published in:
Rozhl. Chir., 2017, roč. 96, č. 1, s. 9-17.
Category:
Original articles
Overview
Introduction:
The incidence of biliary duct injuries requiring surgical reconstruction has stabilised between 0.3−0.7%. Biliary reconstruction in the hands of a trained hepatobiliary surgeon may lead to better short- and long-term outcomes in patients with this infrequent, but serious complication.
Methods:
This study presents a retrospective analysis of single surgeon experience with biliary injury repair during the period of 2007−2016. Extramucosal hepaticojejunostomy on the excluded segment of the jejunal loop was performed without the use of any transanastomotic drain. Immediate reconstruction of on-table recognised injuries was carried out; patients presenting with biliary leak were reconstructed early and patients presenting with biliary stricture underwent reconstruction depending on the degree of obstruction, presence of cholangitis and feasibility of endoscopic or percutaneous intervention. Postoperative complications were evaluated using Dindo-Clavien and ISGLS classification, and the effect of reconstruction was assessed according to McDonald criteria.
Results:
15 biliary reconstructions in 14 patients were performed during the study period. More than a half of the patients experienced some postoperative complication (53.33%); serious complication occurred in 2 patients. One patient (82 years old) died of non-surgical postoperative complications. Biliary leak occurred in three patients (20%), and deep surgical site infection (fasciitis) in four patients (33.33%). The average length of stay was 12.13 days. There was no revisional surgery during the index hospitalisation in any of the patients. There were two readmissions up to 90 days after biliary reconstruction (13.33%). The patients are currently followed up for an average of 4.01 years; compliance with follow-up is 100%. Successful reconstruction was achieved in 92.86% of patients; one patient required rehepaticojejunostomy (7.14%). According to McDonald criteria excellent results were accomplished in 6 patients (42.86%), good results in another 5 patients (35.71%) and 2 patients underwent percutaneous intervention on the reconstruction (14.28%).
Conclusion:
When comparing results among various centres, we should take into account: 1. Experience of the centre/surgeon; 2. Case-mix (exact classification); 3. Timing of reconstruction; 4. Criteria for successful reconstruction; and 5. The length of follow-up. Patients in our centre who fulfil McDonald A and B criteria during the whole follow-up period are considered to have a successful repair. Reconstruction in McDonald C patients is also considered as a success by some authors, although this remains debatable as an early intervention on the reconstruction may be appropriate.
Key words:
cholecystectomy – bile duct injury – hepaticojejunostomy −stricture
Sources
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