Liver Transplantation for the Treatment of Complicated Iatrogenic Biliary Injuries

Abstract

IBDI is an uncommon but challenging indication for LT. These patients have significantly increased rates of early graft loss. IBDI is an independent factor related to increased risk of perioperative death after LT. Further studies are needed to determine the causes of perioperative complications and identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI.

Liver transplantation for the treatment of iatrogenic bile duct injury

“…Although the risk of BDI is low in a patient undergoing cholecystectomy, in general this operation is the main cause of BDI, as cholecystectomy is the most commonly performed abdominal operation worldwide 5 . Most studies, including ours, show that the rate of BDI is higher in females, as cholecystectomy is performed three to four times more commonly in this gender due to the higher prevalence of gallstones in females 5,13 .…”

“…In addition, the rate of lawsuits is quite expressive 12,23,24 . About 80% to 90% of BDI occur in patients undergoing cholecystectomy 13,25 . Currently, the rate of BDI is similar in patients undergoing open or laparoscopic cholecystectomy and varies between 0.1% and 0.6% 4,12,26,27 .…”

“…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 .…”

“…As most surgeons currently have more experience with laparoscopic procedures than with laparotomy ones, it may be preferable to send patients with BDI to an appropriate referral institution 6,7 . 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 .…”

“…Liver transplantation (LT) may represent the only curative and life-saving option for the management of complicated BDI 12,15 . 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 .…”