Iatrogenic biliary tract lesions requiring surgical reconstruction – presentation and classification of the lesions, their reconstruction and evaluation of the results
Authors:
M. Straka 1,2,5; E. Holášková 1,2; L. Burda 1,2; M. Vávrová 3; P. Fojtík 4; M. Škrovina 1,2,5
Authors place of work:
Chirurgické oddělení Nemocnice Nový Jičín
primár: MUDr. M. Škrovina, Ph. D.
1; Komplexní onkologické centrum Nemocnice Nový Jičín
primár: doc. MUDr. R. Soumarová, Ph. D., MBA
2; Oddelení radiologie a zobrazovacích metod Nemocnice Nový Jičín
primár: MUDr. M. Velkoborský
3; Centrum péče o zažívací trakt Vítkovická Nemocnice
vedúci pracoviska: MUDr. O. Urban, Ph. D.
4; Vzdělávací a výzkumný institut AGEL o. p. s., Prostějov
vedúci pracoviska: Ing. Mgr. K. Murtingerová
5
Published in the journal:
Rozhl. Chir., 2017, roč. 96, č. 1, s. 9-17.
Category:
Original articles
Summary
Introduction:
The incidence of biliary duct injuries requiring surgical reconstruction has stabilised between 0.3−0.7%. Biliary reconstruction in the hands of a trained hepatobiliary surgeon may lead to better short- and long-term outcomes in patients with this infrequent, but serious complication.
Methods:
This study presents a retrospective analysis of single surgeon experience with biliary injury repair during the period of 2007−2016. Extramucosal hepaticojejunostomy on the excluded segment of the jejunal loop was performed without the use of any transanastomotic drain. Immediate reconstruction of on-table recognised injuries was carried out; patients presenting with biliary leak were reconstructed early and patients presenting with biliary stricture underwent reconstruction depending on the degree of obstruction, presence of cholangitis and feasibility of endoscopic or percutaneous intervention. Postoperative complications were evaluated using Dindo-Clavien and ISGLS classification, and the effect of reconstruction was assessed according to McDonald criteria.
Results:
15 biliary reconstructions in 14 patients were performed during the study period. More than a half of the patients experienced some postoperative complication (53.33%); serious complication occurred in 2 patients. One patient (82 years old) died of non-surgical postoperative complications. Biliary leak occurred in three patients (20%), and deep surgical site infection (fasciitis) in four patients (33.33%). The average length of stay was 12.13 days. There was no revisional surgery during the index hospitalisation in any of the patients. There were two readmissions up to 90 days after biliary reconstruction (13.33%). The patients are currently followed up for an average of 4.01 years; compliance with follow-up is 100%. Successful reconstruction was achieved in 92.86% of patients; one patient required rehepaticojejunostomy (7.14%). According to McDonald criteria excellent results were accomplished in 6 patients (42.86%), good results in another 5 patients (35.71%) and 2 patients underwent percutaneous intervention on the reconstruction (14.28%).
Conclusion:
When comparing results among various centres, we should take into account: 1. Experience of the centre/surgeon; 2. Case-mix (exact classification); 3. Timing of reconstruction; 4. Criteria for successful reconstruction; and 5. The length of follow-up. Patients in our centre who fulfil McDonald A and B criteria during the whole follow-up period are considered to have a successful repair. Reconstruction in McDonald C patients is also considered as a success by some authors, although this remains debatable as an early intervention on the reconstruction may be appropriate.
Key words:
cholecystectomy – bile duct injury – hepaticojejunostomy −stricture
Zdroje
1. Stilling NM, Fristrup C, Wettergren A, et al. Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study. HPB (Oxford) 2015;17:394−400.
2. Kais H, Hershkovitz Y, Abu-Snina Y, et al. Different setups of laparoscopic cholecystectomy: conversion and complication rates: a retrospective cohort study. Int J Surg 2014;12:1258−61.
3. Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy conversion rates two decades later. JSLS 2010;14:476−83.
4. Sicklick JK, Camp MS, Lillemoe KD, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 2005;241:786−92; discussion 793−5.
5. Jabłońska B, Lampe P. Recontructive biliary surgery in the treatment of iatrogenic bile duct injuries. In: New advances in the basic and clinical gastroenterology, Brzozowski T. (ed.), 2012; Available from: http://www.intechopen.com/books/new-advances-in-the-basicand-clinical-gastroenterology/reconstructive-biliary-surgery-in-the-treatment-of-iatrogenic-bile-duct-injuries.
6. Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford) 2011;13:1−14.
7. Strasberg SM. Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg 2008;15:284−92.
8. Schmidt SC, Settmacher U, Langrehr JM, et al. Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery 2004;135:613−8.
9. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg 2010;211:132−8.
10. Strasberg SM, Pucci MJ, Brunt LM, et al. Subtotal cholecystectomy-”fenestrating” vs “reconstituting” subtypes and the prevention of bile duct Injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg 2016;222:89−96.
11. Strasberg SM, Eagon CJ, Drebin JA. The “hidden cystic duct” syndrome and the infundibular technique of laparoscopic cholecystectomy-the danger of the false infundibulum. J Am Coll Surg 2000;191:661−7.
12. Stewart L, Way LW. Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB (Oxford) 2009; 11: 516–522.
13. Ahrendt SA, Pitt HA. Surgical therapy of iatrogenic lesions of biliary tract. World J Surg 2001;25:1360−5.
14. Benkabbou A, Castaing D, Salloum C, et al. Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries. Surgery 2013;153:95−102.
15. Mercado MÁ, Franssen B, Dominguez I, et al. Transition from a low: to a high-volume centre for bile duct repair: changes in technique and improved outcome. HPB (Oxford) 2011;13:767−73.
16. Thomson BN, Parks RW, Madhavan KK, et al. Early specialist repair of biliary injury. Br J Surg 2006;93:216−20.
17. Třeška V, Skalický T, Šafránek J, et al. [Injuries to the biliary tract during cholecystectomy] Czech. Rozhl Chir 2005;84:13−8.
18. Velidedeoglu M, Arikan AE, Uludag SS, et al. Clinical application of six current classification systems for iatrogenic bile duct injuries after cholecystectomy. Hepatogastroenterology 2015;62:577−84.
19. Chun K. Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg 2014;18:69−72.
20. Felekouras E, Petrou A, Neofytou K, et al. Early or delayed intervention for bile duct injuries following laparoscopic cholecystectomy? A dilemma looking for an answer. Gastroenterol Res Pract 2015; available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333332/
21. Arora A, Nag HH, Yadav A, et al. Prompt repair of post cholecystectomy bile duct transection recognized intraoperatively and referred early: Experience from a tertiary care teaching unit. Indian J Surg 2015;77:99−103.
22. Iannelli A, Paineau J, Hamy A, et al. Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie. HPB (Oxford) 2013;15:611−6
23. Terblanche J, Worthley CS, Spence RA, et al. High or low hepaticojejunostomy for bile duct strictures? Surgery 1990;108:828−34.
24. McDonald ML, Farnell MB, Nagorney DM, et al. Benign biliary strictures: repair and outcome with a contemporary approach. Surgery 1995;118:582-90; discussion 590−1.
25. Bektas H, Kleine M, Tamac A, et al. Clinical application of the Hannover classification for iatrogenic bile duct lesions. HPB Surg 2011;2011:612384.
26. Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011;149:680−8.
27. Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: Treatment and outcome from a national perspective. World J Surg 2016;40:73−80.
28. Pitt HA, Sherman S, Johnson MS, et al. Improved outcomes of bile duct injuries in the 21st century. Ann Surg 2013;258:490−9.
29. Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg 2001;25:1241−4.
30. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101−25.
31. Bektas H, Schrem H, Winny M, et al. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg 2007;94:1119−27.
32. Soupault R, Couinaud C. Sur un procede nouveau de derivation biliaire intra-hepatique: les cholangio-jejunostomies gauche sans sacrifice hepatique. Presse Med 1957;65:1157−59.
33. Hepp J. Hepaticojejunostomy using the left biliary trunk for iatrogenic biliary lesions: the French connection. World J Surg 1985;9:507−11.
34. Blumgart LH, Thompson JN. The management of benign strictures of the bile duct. Curr Probl Surg 1987;24:1−66.
35. Winslow ER, Fialkowski EA, Linehan DC, et al. “Sideways”: results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. Ann Surg 2009;249:426−34.
36. Mercado MA, Chan C, Orozco H, et al. Long-term evaluation of biliary reconstruction after partial resection of segments IV and V in iatrogenic injuries. J Gastrointest Surg 2006;10:77−82.
37. Sirichindakul B, Nonthasoot B, Suphapol J, et al. Partial segment-IV/V liver resection facilitates the repair of complicated bile duct injury. Hepatogastroenterology 2009;56:956−9.
38. Silva MA, Coldham C, Mayer AD, et al. Specialist outreach service for on-table repair of iatrogenic bile duct injuries – a new kind of ‘travelling surgeon’. Ann R Coll Surg Engl 2008;90:243−6.
39. Pekolj J, Alvarez FA, Palavecino M, et al. Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 2013;216:894−901.
40. Perera MT, Silva MA, Hegab B, et al. Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injuries is associated with an improved long-term outcome. Ann Surg 2011;253:553−60.
41. Patrono D, Benvenga R, Colli F, et al. Surgical management of post-cholecystectomy bile duct injuries: referral patterns and factors influencing early and long-term outcome. Updates Surg 2015;67:283−91.
42. Loveček M, Havlík R, Klein J, et al. [Iatrogenic bile ducts injuries] Czech. Rozhl Chir 2010;89:183−7.
43. AbdelRafee A, El-Shobari M, Askar W, et al. Long-term follow-up of 120 patients after hepaticojejunostomy for treatment of post-cholecystectomy bile duct injuries: A retrospective cohort study. Int J Surg 2015;18:205−10.
44. Hoskovec D, Jaroš K, Hledík E, et al. Iatrogenní léze žlučových cest – možnosti terapie a dlouhodobé výsledky léčby. Bulletin HPB: Časopis české hepato-pankreato-biliární chirurgie 2003;11:63−5.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2017 Číslo 1
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Internal hernia as a cause of small bowel obstruction
- Colorectal cancer − the importance of primary tumor location
- Iatrogenic biliary tract lesions requiring surgical reconstruction – presentation and classification of the lesions, their reconstruction and evaluation of the results
- Experience with hepatoblastoma treatment in small children – the use of preoperative 3D virtual analysis MeVis for liver resections