Results of delayed surgical treatment of the complete section of the biliary tract (Strasberg E) after cholecystectomy at a reference center

Abstract

Aims: Laparoscopic cholecystectomy has been set as the 'gold standard' treatment for cholelithiasis, but unfortunately, it has also been associated with a higher incidence of iatrogenic lesions of the biliary tract (0.36%e0.47%). Although lesions repair must be preferably done at the same surgical time, this is not always possible because of its late diagnosis, and the fact that an expert surgeon is not always available. The goal of this study is to describe the features and results of the delayed surgical repair of the complete biliary tract sections (CBTS) (Strasberg E) at a reference center. Methods: A retrospective study was conducted with all patients presenting CBTS between January 2000 and April 2014 and followed up until November 2014. Patients with immediate intraoperative repair or those repaired in other centers were excluded. Biliary tract injuries were described according to the Bismuth-Strasberg, Hanover and the new ATOM classifications. Complications were defined following the Dindo-Clavien classification. Results: Twenty four patients were included in the study with a median follow up of 632 days (Range 180e4496). Preoperative angioCT was performed in all cases and MRI in 91.7%.An hepaticojejunostomy was performed in all cases associated with liver resection in 3 cases. Surgical morbidity rate was 50%, but 69.2% of them were mild (<IIIb), being the infection of the surgical site the most common (41.7%).Three patients required immediate reoperation. Postoperative mortality occurred in one patient (4.2%) due to a hemorrhagic shock. Three patients showed late surgical complications (stenosis of the anastomosis, intra-abdominal abscess and biliary fistula), that were treated by CTPH, surgical drainage and conservative management respectively. No late mortality was observed. Conclusions: Delayed hepaticojejunostomy in a reference unit is an effective surgical solution for CBTS. This treatment is associated with a high mild-grade early morbidity rate and low-late morbidity and mortality rates.