Long-term consequences of bile duct injury after cholecystectomy

Abstract

Late complications arising after bile duct injury (BDI) include biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis. Secondary biliary cirrhosis resulting in associated hepatic failure or digestive tract bleeding due to portal hypertension is a substantial risk factor for morbidity and mortality after bile duct repair. Parameters that determine the management of late complications of BDI include the type of biliary injury, associated vascular injury, hepatic atrophy, the presence of intra-hepatic strictures or lithiasis, repetitive infectious complications, the quality of underlying parenchyma (fibrosis, secondary biliary cirrhosis) and the presence of portal hypertension. Endoscopic drainage is indicated for patients with uncontrolled acute sepsis, patients at high operative risk, patients with cirrhosis who are not eligible for liver transplantation and patients who have previously undergone several attempts at repair. Roux-en-Y hepaticojejunostomy, whether de novo or as an iterative repair, is the technique of reference for post-cholecystectomy BDI. Hepatic resection is indicated in only rare instances, mainly in case of extended hilar stricture, multiple stone retention in one sector of the liver or in patients for whom the repair is deemed technically difficult. Liver transplantation is indicated only in exceptional circumstances, when secondary biliary cirrhosis is associated with liver failure and portal hypertension.

Bile Duct Injury after Cholecystectomy: Surgical Therapy

“…Biliary reconstruction by the primary surgeon results in success rates between 17 and 30% [41,[48][49][50]. Data suggest that these injuries should be managed by a hepatobiliary surgeon with extensive expertise in biliary reconstruction as outcomes can be excellent; many expert surgical series report long-term success rates of more than 90% [51][52][53][54][55][56][57][58]. Given that management of these injuries often requires an experienced multidisciplinary team (including interventional radiology, gastroenterology, and surgery), they are best handled in a tertiary referral center.…”

Endoscopic and Surgical Management of Iatrogenic Biliary Tract Injuries

“…Leakage was spontaneously closed after ERCP without any additional intervention in nine patients, all with the low-output leakage. The period for the spontaneous closure after ERCP was average seven (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days. Spontaneous closure was achieved in 14 patients who underwent sphincterotomy during ERCP and in 56 patients who underwent plastic stent placement additionally to sphincterotomy.…”

“…Biliary duct injury from these complications after cholecystectomy is the most feared major complication with high morbidity (9.3%-43%) and early mortality (0%-1.7%). [6,7] Biliary tract injury after cholecystectomy was evaluated in many previous studies. [6,7] The importance of endoscopic treatment was emphasized in many of them, and morbidity and mortality rates were reported to be increased, especially in late diagnosis and the cases which had to undergo surgery.…”

Factores predictores perioperatorios de complicaciones de la colecistectomía por laparoscopia

“…Este factor permite, además, demostrar disminución en la estancia hospitalaria, el dolor posoperatorio y los costos de la atención 11,30 . Teniendo en cuenta que las lesiones de vía biliar abarcan desde aquellas simples con fuga del muñón cístico, que pueden requerir un manejo expectante, hasta las complejas que obligan a reconstruir la vía biliar 31 , se calcularon las tasas de este tipo de complicaciones comparándolas con la tasa global reportada en la literatura, de hasta 0, 7 % 19 , porcentaje que incluye lesiones avanzadas según la clasificación de Strasberg. En el presente estudio se obtuvo un porcentaje muy por debajo de la tasa global para este tipo de lesiones, 0,08 %.…”