The Long-Term Outcome of Hepaticojejunostomy in the Treatment of Benign Bile Duct Strictures

Tocchi, A; Costa, Gianluca; Lepre, L; Liotta, G; Mazzoni, Gianluca; Sita, A

doi:10.1097/00000658-199608000-00008

Cited by 160 publications

(153 citation statements)

References 26 publications

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“…4,5 Series reporting long term results after BDI repair following open cholecystectomy have shown similar results to those after laparoscopic cholecystectomy. [6][7][8][9] We did not observe any effect of cholecystectomy technique affecting outcome in this study.…”

Section: Discussionmentioning

confidence: 91%

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Gomes¹

2015

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Section: Discussionmentioning

confidence: 91%

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Gomes¹

2015

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“…Similarly, there was no relationship between the level of biliary-enteric anastomosis and the development of stricture, [15][16][17] despite reports describing better results with hepaticojejunostomy than with choledochojejunostomy, 18 and others showing that high biliary injuries are associated with vascular injury. 9,14,19 Postoperative chemotherapy was not associated with an increased risk of stricture, 3 with a median time to biliary stricture of 12 months, when most of the patients were alive. With a median follow up of 11 months (range 0-78), it is likely that the actual rate of stricture may be higher, even though most strictures occur within the first 2 years.…”

Section: Discussionmentioning

confidence: 96%

Complications of biliary-enteric anastomoses

Khorsandi

et al. 2017

annals

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INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliaryenteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed. Of these, 347 (75%) were performed for malignant disease. Roux-en-Y hepaticojejunostomy or choledocho-jejunostomy were performed in 440 (95%) patients. Perioperative 30-day mortality was 6.5% (n=30). Seventeen patients had early bile leaks (3.7%) and 17 had late strictures (3.7%) at a median of 12 months. On univariable logistic regression analysis, younger age was a significant risk factor for biliary anastomotic leak. However, on multivariable analysis only biliary reconstruction following biliary injury (odds ratio [OR]=6.84; p=0.002) and anastomosis above the biliary confluence (OR=4.62; p=0.03) were significant. Younger age and biliary reconstruction following injury appeared to be significant risk factors for biliary strictures but multivariable analysis showed that only younger age was significant. CONCLUSIONS Biliary-enteric anastomoses have a low incidence of early and late complications. Biliary reconstruction following injury and a high anastomosis (above the confluence) are significant risk factors for anastomotic leak. Younger patients are significantly more likely to develop an anastomotic stricture over the longer term.

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“…13 The endoscopic or radiologically guided intervention may not be successful as a primary treatment in the more complex injuries 12 but it is certainly advantageous in recurrent anastomotic strictures or in patients not suitable for surgery. 12,17,24,25 The main option for correction of a bile duct injury is a Roux-en-Y HJS with tension-free mucosa-to-mucosa anastomosis. 24,26 This is a demanding operation, especially because the bile ducts are usually of normal diameter, and proper, viable anastomosis necessitates dissection high up in the hepatic hilum.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective review of 84 patients who underwent biliary enteric anastomosis for benign bile duct strictures the best results correlated with high level of anastomosis and with the degree of common bile duct dilatation independently of stricture location. 25 The high anastomosis is preferable because of the critical blood supply to the supraduodenal portion of biliary tree. 28 Eighty-two percent of patients operated before referral underwent a reoperation in our unit.…”

Section: Discussionmentioning

confidence: 99%

Management and outcome of major bile duct injuries after laparoscopic cholecystectomy: From therapeutic endoscopy to liver transplantation

et al. 2002

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Laparoscopic cholecystectomy is associated with a higher rate of bile duct injuries than an open cholecystectomy. The annual incidence of bile duct injuries has remained almost constant and these injuries tend to be more serious, making demands on the method of repair. We wanted to report the management and outcome of major bile duct injuries after laparoscopic cholecystectomy in patients referred to a hepatobiliary and liver transplantation unit. Eighteen patients (14 women), with a median age of 53.5 years were referred to the liver surgery unit with a major bile duct injury after laparoscopic cholecystectomy. The injury was identified after a median of 3 days (range, 0 to 25 days) after operation and the median time interval to referral was 79 days (0 to 2270 days). Fourteen patients had undergone surgery before referral. By the time of referral, four patients had developed end-stage cirrhosis, necessitating liver transplantation. Three of them had undergone bilioenteric drainage operations at the referring institute. Of the remaining 14 patients, three were managed by therapeutic endoscopic procedures. Ten patients were managed with Roux-en-Y hepaticojejunostomy. One died of septic complications before the repair. A median time for hospitalization in our unit was 33 days (range,10 to 164 days). At present, 16 patients are alive. One patient died of Kaposi's sarcoma 7 months after liver transplantation. A long interval between bile duct injury and referral was associated with the development of endstage liver disease. Surgery of biliary lesions is demanding, and surgical experience with multidisciplinary approach, including therapeutic endoscopy and liver transplantation, is necessary for successful outcome. (Liver Transpl

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The Long-Term Outcome of Hepaticojejunostomy in the Treatment of Benign Bile Duct Strictures

Cited by 160 publications

References 26 publications

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Complications of biliary-enteric anastomoses

Management and outcome of major bile duct injuries after laparoscopic cholecystectomy: From therapeutic endoscopy to liver transplantation

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