Liver Transplantation for Bile Duct Injury After Cholecystectomy

Abstract

BACKGROUND: Bile duct injury is a life-threatening complication that requires proper management to prevent the onset of negative outcomes. Patients may experience repeated episodes of cholangitis, secondary biliary cirrhosis, end-stage liver disease and death. OBJECTIVE: To report a single center experience in iatrogenic secondary liver transplantation after cholecystectomy and review the literature. METHODS: This was a retrospective single center study. Of the 1662 liver transplantation realized, 10 (0.60 %) were secondary to iatrogenic bile ducts injuries due cholecystectomies. Medical records of these patients were reviewed in this study. RESULTS: Nine of 10 patients were women; the median time in waiting list and between cholecystectomy and inclusion in waiting list was of 222 days and of 139.9 months, respectively. Cholecystectomy was performed by open approach in eight (80%) cases and by laparoscopic approach in two (20%) cases. The patients underwent an average of 3.5 surgeries and procedures before liver transplantation. Biliary reconstruction was realized with a Roux-en-Y hepaticojejunostomy in nine (90%) cases. Mean operative time was 447.2 minutes and the median red blood cell transfusion was 3.4 units per patient. Mortality in the first month was of 30%. CONCLUSION: Although the liver transplantation is an extreme treatment for an initially benign disease, it has its well-defined indications in treatment of bile duct injuries after cholecystectomy, either in acute or chronic scenario.

Liver transplantation for the treatment of iatrogenic bile duct injury

“…Multiple endoscopic, radiological, and surgical treatments employed in these patients possibly delayed the development of advanced liver failure. Chiche et al 25 and Silva Filho et al 19 also reported a long time interval between the occurrence of BDI and LT.…”

“…Unlike publications from the USA and Europe, but similar to another Brazilian study, most of our patients were initially submitted to open cholecystectomy 2,[7][8][9][10][11]13,19 .…”

“…Some factors such as delay in establishing the correct diagnosis, late referral to the tertiary center, injury at or above the right and left bile duct junction, simultaneous vascular injuries, and multiple previous surgical procedures for the treatment of BDI have a negative impact on the BDI long-term treatment outcome 4,6,13,27 . Some patients with BDI associated with severe damage to the hepatic artery and portal vein may develop acute liver failure due to massive hepatic necrosis and require emergency liver transplantation 6,12,19 . All of our 12 patients who underwent LT for BDI had multiple sessions of endoscopic and radiological treatment.…”

“…Several authors have also demonstrated that multiple endoscopic, radiological, and surgical procedures are often necessary to treat major BDI and its complications 13,19,25 . Despite these diverse therapeutic options, some patients progress to a critical condition due to complications secondary to biliary cirrhosis and chronic liver failure.…”

“…There are few publications on LT in patients with BDI [12][13][14][15][16][17][18] . In Brazil, there is only one manuscript with a small series of cases on this important subject 19 . The aim of the present study is to evaluate the results of patients who underwent LT for BDI in our hospitals.…”