Factors Predicting Advanced Hepatic Fibrosis in Patients With Postcholecystectomy Bile Duct Strictures

Negi, Sanjay Singh; Sakhuja, Puja; Malhotra, Veena; Chaudhary, Adarsh

doi:10.1001/archsurg.139.3.299

Cited by 54 publications

(40 citation statements)

References 16 publications

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“…The time required for the development of secondary biliary cirrhosis after benign biliary stenosis is reported to be 7.1 years: 4.6 years for those with common bile duct stones, and 0.8 years for patients with malignant biliary obstruction [29]. Recent studies describe the time of obstruction, the basal alanine aminotransferase (ALT) level, and the time to normalization of ALT level after surgical repair as predictive factors in the development of hepatic fibrosis [30].…”

Section: Secondary Biliary Cirrhosis and Portal Hypertensionmentioning

confidence: 99%

Bile duct injuries: management of late complications

et al. 2006

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Section: Secondary Biliary Cirrhosis and Portal Hypertensionmentioning

confidence: 99%

Bile duct injuries: management of late complications

et al. 2006

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“…They are most frequently caused by laparoscopic cholecystectomy, which is one of the commonest surgical procedures in the world [1] . The early and accurate diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death [2,3] . The choice of the appropriate treatment for IBDI is very important, because it may avoid these serious complications and improve quality of life in patients.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic bile duct injuries: Etiology, diagnosis and management

Jabłońska¹,

Lampe²

2009

WJG

124

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Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Rouxen-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is endto-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

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“…In a study by Negi et al, [17] of 64 patients of post cholecystectomy strictures, duration of symptoms ranged from 1-120 months and a longer duration of biliary obstruction was found to be the most important predictor of advanced hepatic fibrosis. In our study, the range of duration of symptoms was shorter (0.5-36 moths) and fibrosis was less commonly seen with shorter duration of symptoms similar to above study.…”

Section: Discussionmentioning

confidence: 96%

“…In a study of 116 patients by Chalya et al, [14] higher number of patients (58.6%) had association with malignant etiology but choledocholithiasis was the commonest (62.5%) cause among benign (62.5%) and carcinoma of the head of pancreas (64.7%) among the malignant causes similar to our study. However, in the studies by Sikora et al, [9] Hammel et al [13] and Negi et al, [17] patients with only benign etiology were included. We also analyzed the cause of obstruction with respect to age and gender, benign causes were more prevalent in females and in younger (<40yrs) age group while malignant causes were more prevalent in males and in older age group.…”

Section: Discussionmentioning

confidence: 99%

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

Chaturvedi¹,

Chaudhari²,

Kekan³

et al. 2017

APALM

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Background: Biliary obstruction can present with distressing symptoms and increased morbidity which leads to liver fibrosis, cholestasis, portal inflammation and ductular proliferation. Experimental studies showed reversal of histological findings in liver after biliary decompression surgery; however only a limited data is available regarding the same. Methods:Prospective observational study of 28 liver biopsies from 14 patients of obstructive jaundice, who underwent decompression surgery and showed clinical deterioration at 6 weeks with normal HIDA scan. Patients were clinically evaluated. Both intra (1st bx) and postoperative (2nd bx) liver biopsies were studied for fibrosis, cholestasis, ductular proliferation and portal inflammation.Result: Patient's age ranged from 24 to 75 years (8 Males and females 6), commonest symptom being jaundice. In 1st bx, most of the patients showed histological evidence of obstruction, which improved at least partially after surgery. There was no definite correlation of fibrosis with etiology. Fibrosis was less commonly seen with shorter duration of symptoms and younger males had higher prevalence. Increase/ static grades of fibrosis were seen in 35.71% patients each, while 28.57% showed regression. No correlation of age and etiology with status of fibrosis was observed. Regression was more common in males and with absence of cholangitis while progression was more common in females and with presence of cholangitis. Conclusion:We wonder whether younger males are more prone for fibrosis but males in general have better prognosis regarding the reversal. Also, cholangitis could be an important factor for deciding the further course of fibrosis. However we require larger data with multivariate analysis for the confirmation of the same.

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Factors Predicting Advanced Hepatic Fibrosis in Patients With Postcholecystectomy Bile Duct Strictures

Cited by 54 publications

References 16 publications

Bile duct injuries: management of late complications

Bile duct injuries: management of late complications

Iatrogenic bile duct injuries: Etiology, diagnosis and management

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

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