Liver transplantation for bile duct injury after open and laparoscopic cholecystectomy

Abstract

BackgroundBile duct injury (BDI) after cholecystectomy is a serious complication. In a small subset of patients with BDI, failure of surgical or non-surgical management might lead to acute or chronic liver failure. The aim of this study was to review the indications and outcome of liver transplantation (LT) for BDI after open and laparoscopic cholecystectomy.MethodsPatients with BDI after cholecystectomy who were on the waiting list for LT between January 1987 and December 2010 were identified from LT centres in Spain. A standardized questionnaire was sent to each unit for extraction of data on diagnosis, previous treatments, indication and outcome of LT for BDI.ResultsSome 27 patients with BDI after cholecystectomy in whom surgical and non-surgical management for BDI failed were scheduled for LT over the 24-year interval. Emergency LT for acute liver failure was indicated in seven patients, all after laparoscopic cholecystectomy. Two patients died while on the waiting list and only one patient survived more than 30 days after LT. Elective LT for secondary biliary cirrhosis after a failed hepaticojejunostomy was performed in 13 patients after open and seven after laparoscopic cholecystectomy. One patient from the elective transplantation group died within 30 days of LT. The estimated 5-year overall survival rate was 68 per cent.ConclusionEmergency LT for acute liver failure was more common in patients with BDI after laparoscopic cholecystectomy, and associated with a poor outcome.

Portal Vein Thrombosis Associated With Right Hepatic Artery Injury During Cholecystectomy: An Uncommon Indication for Urgent Liver Transplantation

“…The indication for urgent liver transplantation is the context of liver failure with acute coagulopathy and secondary multiple organ failure, with transplantation as the only valid therapeutic option. Although the number of case reports is limited, this affirmation is supported by other authors, [6][7][8][9] and the recently published series by Parrilla et al 10 on biliary duct lesions is especially interesting. Nonetheless, due to the severe nature of these indications, these situations should be carefully assessed after continuous clinical follow-up in order to choose the right time for transplantation.…”

Surgical management of post-cholecystectomy bile duct injuries: referral patterns and factors influencing early and long-term outcome

“…Sepsis at referral and need for laparotomy before surgical repair are the factors significantly associated with the development of severe complications. The analysis of referral patterns and subsequent surgical treatment confirms that BDI management requires the most comprehensive array of surgical techniques in the armamentarium of the hepatobiliary surgeon, including complex biliary reconstructions, major hepatic resections, and in selected cases liver transplantation [18]. Furthermore, surgery needs to be properly integrated with operative endoscopy and interventional radiology.…”

Bile Duct Injury after Cholecystectomy: Surgical Therapy

“…In a small subset of patients with IBDI, failure of surgical or non-surgical management might lead to acute or chronic liver failure necessitating LT. In this regard, over a 24-year period, Parrilla et al [73] analyzed 27 patients scheduled for LT with IBDI after cholecystectomy in whom surgical and non-surgical management for IBDI had failed. Emergency LT for acute liver failure was indicated in 7 patients after LC.…”