Long-Term Results in the Surgical Treatment of Iatrogenic Bile Duct Injuries

Abstract

The aim of the study was analysis of long-term results in patients following different methods of the surgical treatment of iatrogenic bile duct injuries. material and methods. Between January 1990 and March 2005, 138 patients -37 (26.8%) men and 101 (73.2%) women were operated for IBDI in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice. The mean age was 52.9 (18-85) years. The following reconstructions were performed: Roux-Y hepaticojejunostomy (49), end-to-end ductal anastomosis (45), jejunal interposition hepaticoduodenostomy (27), bile duct plastic reconstruction (6), choledochoduodenostomy (2) and others (8). Long-term results were assessed based on anamnesis, physical examination and accessory investigations (laboratory an ultrasonography of the abdominal cavity). Obtained results were classified according Terblanche scale. Quality of life was classified according to the Karnofsky Performance Score. Results. Information of long-term results was obtained in 91 (66%) patients. Long-term results according to Terblanche classification were the following: I grade -58 (63.7%) patients, II grade -14 (15.4%) patients, III grade -13 (14.3%) patients, IV grade (recurrent anastomosis stricture) -6 (6.6%) patients. Quality of life according to Karnofsky Performance Score was very good (the highest number of 100 points) in most (40.5%) patients. conclusions. Surgical reconstructions of IBDI are procedures that require maximal precision and knowledge of different methods of reconstruction of biliary tract continuity. The choice of the method depends on the situation in the operation area. Achievement of successful long-term results is possible in referral centers experienced in hepatobiliary surgery.

End-to-end ductal anastomosis in biliary reconstruction: indications and limitations

“…Different biliary reconstructions have been reported in the surgical treatment of IBDI: Roux-en-Y HJ, end-to-end ductal biliary anastomosis, choledochoduodenostomy, Lahey HJ, jejunal interposition hepaticoduodenostomy, Blumgart (Hepp) anastomosis, Heinecke-Mikulicz biliary plastic reconstruction and Smith mucosal graft. 2,19,20 Hepaticojejunostomy versus end-to-end ductal anastomosis in the surgical treatment of IBDI Currently, Roux-en-Y HJ is the most common surgical reconstruction of IBDI.…”