Actuarial Patency Rates of Hepatico-Jejunal Anastomosis after Repair of Bile Duct Injury at a Reference Center

Abstract

Background: Bile duct injury complicates patients’ lives, despite the subsequent repair. Repairing the injury must restore continuity of the bile tree and bring the patient into a state of cure referred to as “patency”. Actuarial primary or actuarial secondary patency rates, depending on whether the patient underwent primary or secondary repair of injury, are proposed to be a proper metric in evaluating outcomes. This study was undertaken to assess outcomes of 669 patients with bile duct injuries Strasberg D and E type referred to the department from public surgical wards between 1990 and 2020. In 442 patients, no attempt was made to repair prior to a referral, and in 227 an attempt to repair was made which failed. Methods: Observations were summarized on December 31st, 2020. The retrospective analysis included: primary patency attained (Grade A result), secondary patency attained (Grade C result), patency loss, and actuarial patency rates of the bile tree at 2, 5, and 10 years. Results: Twenty-five (3.7%) patients died after repair surgery. Actuarial patency rates at 2, 5, and 10 years of follow-up were 93%, 88%, and 74% or 86%, 75%, and 55% in patients attaining Grade A and Grade C outcomes, respectively (p < 0.001). Conclusion: Bile duct injury stands out as a surgical challenge, requiring specialized management at a referral center. Improper proceeding after an injury is the factor leading to faster loss of anastomotic patency.

Application of Three-dimensional Visualization Technology in Early Surgical Repair of Bile Duct Injury During Laparoscopic Cholecystectomy

“…The key to the successful repair of high-level bile duct injury is the exposure of the damaged bile duct opening. This often requires descending or perihilar resection to repair the normal bile duct opening and then complete Roux-en-Y hepaticojejunostomy [18][19]. In clinical practice, 3D visualization technology has been well applied in the perihilar resection of hilar cholangiocarcinoma [20][21].…”

Online calculators for predicting the risk of anastomotic stricture after hepaticojejunostomy for bile duct injury after cholecystectomy: a multicenter retrospective study

“…Almost all relevant studies have shown that the timing of sound biliary repair by experienced surgeons is a critical factor in improving the prognosis of BDI patients 5 , 22 – 24 . Previous studies revealed that the success rate of repair performed by specialists can reach 79%; however, it is lower than 30% in the case of nonspecialists or beginners 25 , 26 .…”

Bile Duct Reconstruction after Failed Laparoscopic Cholecystectomy: Literature Review

“…Конечно, вопрос о выборе времени для реконструктив ной операции является в настоящее время открытым и требует консенсуса, обозначенного клиническими рекомендациями [27]. С каждой последующей реопера цией шансы на развитие стриктуры анастомоза увели чиваются [28,29]. Что касается послеоперационной диагностики повреж дения желчных протоков, то наиболее ранними сим птомами являются боль в животе, напряжение мышц передней брюшной стенки, повышение температуры, тошнота и рвота, появление желтухи.…”