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Liver transplantation as a lifesaving procedure for posthepatectomy liver failure and iatrogenic liver injuries. Langenbecks Arch Surg 2019; 404:301-308. [DOI: 10.1007/s00423-019-01780-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/20/2019] [Indexed: 12/13/2022]
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2
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Leale I, Moraglia E, Bottino G, Rachef M, Dova L, Cariati A, De Negri A, Diviacco P, Andorno E. Role of Liver Transplantation in Bilio-Vascular Liver Injury After Cholecystectomy. Transplant Proc 2017; 48:370-6. [PMID: 27109958 DOI: 10.1016/j.transproceed.2015.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to report 2 cases of liver transplantation (LT) for iatrogenic bile-vascular injury (BVI) sustained during cholecystectomy and to review the literature for LT after cholecystectomy. METHODS Between March 2001 and July 2013, within our institution, 12 patients were treated after cholecystectomy, 3 of 12 received LT, 1 for acute de-compensation in a cirrhotic patient and 2 after iatrogenic lesions. RESULTS The majority of iatrogenic injury occurred during video-laparocholecystectomy (63,6%; 7/11). Three patients of 12 (25%) received LT: the first patient developed acute de-compensation in chronic and after liver failure. The second patient developed recurrent cholangitis and secondary biliary cirrhosis. The third patient had undergone emergency hepatectomy because of bleeding and subsequent total hepatectomy with porto-caval shunt. Five of 12 (42%) patients were treated with bilio-digestive anastomosis: 1 patient with direct repair on T-tube; 2 patients (17%) with arterial vascular lesion requiring surgical treatment; and 1 patient treated with medical therapy. No deaths occurred. The post-operative morbidity included 1 re-intervention, 3 recurrent cholangitis, 1 anastomotic biliary stricture, 1 anastomotic bile leak, and cholestasis in 3 patients. The overall hospital stays were higher after LT. Median follow-up was 8.25 years (range, 2-14). CONCLUSIONS The management of iatrogenic injury during cholecystectomy depends on the time of recognition, extent of injury, experience of the surgeon, and the patient's general condition. If safe repair is possible, BVI should be treated promptly, otherwise all patients should be treated in an experienced center.
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Affiliation(s)
- I Leale
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
| | - E Moraglia
- Emergency Department, IRCCS San Martino-IST, Genoa, Italy
| | - G Bottino
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy
| | - M Rachef
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy
| | - L Dova
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy
| | - A Cariati
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy
| | - A De Negri
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy
| | - P Diviacco
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy
| | - E Andorno
- HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy
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3
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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.
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Affiliation(s)
- L Barbier
- Chirurgie Digestive et Transplantation Hépatique, Hôpital La Conception, Assistance publique-Hôpitaux de Marseille, Aix-Marseille Université, 147, boulevard Baille, 13385 Marseille cedex 5, France.
| | - R Souche
- Chirurgie Digestive A, Hôpital Saint-Éloi, Centre Hospitalo-Universitaire, Montpellier, France
| | - K Slim
- Service de Chirurgie Digestive, Unité de Chirurgie Ambulatoire, CHU Estaing, Clermont-Ferrand, France
| | - P Ah-Soune
- Gastro-Entérologie et Hépatologie, Centre Hospitalier Régional de Toulon, Toulon, France
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Addeo P, Saouli AC, Ellero B, Woehl-Jaegle ML, Oussoultzoglou E, Rosso E, Cesaretti M, Bachellier P. Liver transplantation for iatrogenic bile duct injuries sustained during cholecystectomy. Hepatol Int 2013. [DOI: 10.1007/s12072-013-9442-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Benkabbou A, Castaing D, Salloum C, Adam R, Azoulay D, Vibert E. Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries. Surgery 2013; 153:95-102. [DOI: 10.1016/j.surg.2012.06.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 06/14/2012] [Indexed: 11/29/2022]
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Ardiles V, McCormack L, Quiñonez E, Goldaracena N, Mattera J, Pekolj J, Ciardullo M, de Santibañes E. Experience using liver transplantation for the treatment of severe bile duct injuries over 20 years in Argentina: results from a National Survey. HPB (Oxford) 2011; 13:544-50. [PMID: 21762297 PMCID: PMC3163276 DOI: 10.1111/j.1477-2574.2011.00322.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bile duct injury (BDI) is a severe complication that may arise during the surgical treatment of benign disease and a few patients will develop end-stage liver disease (ESLD) requiring a liver transplant (LT). OBJECTIVE Analyse the experience using LT as a definitive treatment of BDI in Argentina. PATIENTS AND METHODS A national survey regarding the experience of LT for BDI. RESULTS Sixteen out 18 centres reported a total of 19 patients. The percentage of LT for BDI from the total number of LT per period was: 1990-94 = 3.1%, 1995-99 = 1.6%, 2000-04 = 0.7% and 2005-09 = 0.2% (P < 0.001). The mean age was 45.7 ± 10.3 years (range 26-62) and 10 patients were female. The BDI occurred during cholecystectomy in 16 and 7 had vascular injuries. One patient presented with acute liver failure and the others with chronic ESLD. The median time between BDI and LT was 71 months (range 0.2-157). The mean follow-up was 8.3 years (10 months to 16.4 years). Survival at 1, 3, 5 and 10 years was 73%, 68%, 68% and 45%, respectively. CONCLUSIONS The use of LT for the treatment of BDI declined over the review period. LT plays a role in selected cases in patients with acute liver failure and ESLD.
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Affiliation(s)
- Victoria Ardiles
- General Surgery Service and Liver Transplant Unit, Hospital Italiano de Buenos AiresBuenos Aires, Argentina
| | - Lucas McCormack
- General Surgery and Liver Transplant Unit, Hospital Alemán de Buenos AiresBuenos Aires, Argentina
| | - Emilio Quiñonez
- General Surgery and Liver Transplant Unit, Hospital Alemán de Buenos AiresBuenos Aires, Argentina
| | - Nicolás Goldaracena
- General Surgery and Liver Transplant Unit, Hospital Alemán de Buenos AiresBuenos Aires, Argentina
| | - Juan Mattera
- General Surgery Service and Liver Transplant Unit, Hospital Italiano de Buenos AiresBuenos Aires, Argentina
| | - Juan Pekolj
- General Surgery Service and Liver Transplant Unit, Hospital Italiano de Buenos AiresBuenos Aires, Argentina
| | - Miguel Ciardullo
- General Surgery Service and Liver Transplant Unit, Hospital Italiano de Buenos AiresBuenos Aires, Argentina
| | - Eduardo de Santibañes
- General Surgery Service and Liver Transplant Unit, Hospital Italiano de Buenos AiresBuenos Aires, Argentina
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Ruiz Gómez F, Ramia Ángel JM, García-Parreño Jofré J, Figueras J. Lesiones iatrogénicas de la vía biliar. Cir Esp 2010; 88:211-21. [DOI: 10.1016/j.ciresp.2010.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 02/21/2010] [Accepted: 03/12/2010] [Indexed: 12/20/2022]
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Abstract
BACKGROUND Bile duct injury (BDI) is a severe complication that may arise during the surgical treatment of a benign disease. A significant proportion of cases develop end-stage liver disease and a liver transplant is required. The aim of this study was to analyze the indications and results of liver transplantation as treatment for BDI. METHODS Between January 1988 and May 2007, 20 patients with end-stage liver disease secondary to BDI were included on the liver transplant waiting list. Retrospective charts were analyzed and survival was estimated by the Kaplan-Meier test. RESULTS Four patients died while on the waiting list and 16 received a transplant. Injury to the bile duct occurred during a cholecystectomy in 13 of 16 patients, with the main cause of the lesion being duct division in six patients and resection in four. All patients had received some surgical treatment (median = 2 procedures) before being considered for a transplant. The liver transplant came from a cadaveric donor for all patients and the median time between BDI and liver transplant was 60 months. Two patients died in the postoperative period and nine had complications. Three patients died in the late postoperative period. Median follow-up was 62 (range = 24-152) months. One-, three-, and five-year survival rates were 81, 75, and 75%, respectively. CONCLUSION Complex bile duct injuries and bile duct injuries with previous repair attempts can result in end-stage liver disease. In these cases, liver transplantation provides long-term survival.
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Abstract
BACKGROUND Postcholecystectomy complex bile duct injuries involving the hilar confluence, which are often associated with vascular injuries and liver atrophy, remain a considerable surgical challenge. The aim of this study is to report our experience of major hepatectomy with long-term outcome in these patients. METHODS From January 1987 to January 2002, 18 patients underwent a major hepatectomy for complex bile duct injuries. The hilar confluence was involved in all cases and was associated with vascular injuries in 13 (72%), including arterial injuries in 11, and partial liver atrophy in 15 (83%). The average time interval between the initial cholecystectomy and hepatectomy was 43 +/- 63 months and 16 (88%) patients had previously undergone an average of 2 (range 1-3) surgical repairs. RESULTS Major liver resection included a right hepatectomy in 14 (78%) patients, a left hepatectomy in 3, and a left trisectionectomy in one. There was no postoperative mortality, but severe postoperative morbidity was experienced in 11 (61%) patients, including biliary fistula in 7 (39%), prolonged ascites in 8 (44%) and hemorrhage requiring reoperation in one. With a median follow-up time of 8 years (range 3 to 12), 17 (94%) patients have excellent or good results, including 13 patients without symptoms. CONCLUSION This study shows that salvage major hepatectomy is an efficient treatment for patients with complex hilar bile duct injuries and should be considered before liver transplantation or recourse to metallic stents.
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de Reuver PR, Busch ORC, Rauws EA, Lameris JS, van Gulik TM, Gouma DJ. Long-term results of a primary end-to-end anastomosis in peroperative detected bile duct injury. J Gastrointest Surg 2007; 11:296-302. [PMID: 17458601 PMCID: PMC1915638 DOI: 10.1007/s11605-007-0087-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The management of a bile duct injury detected during laparoscopic cholecystectomy is still under discussion. An end-to-end anastomosis (with or without T-tube drainage) in peroperative detected bile duct injury has been reported to be associated with stricture formation of the anastomosis area and recurrent jaundice. Between 1991 and 2005, 56 of a total of 500 bile duct injury patients were referred for treating complications after a primary end-to-end anastomosis. After referral, 43 (77%) patients were initially treated endoscopically or by percutaneous transhepatic stent placement (n = 3; 5%). After a mean follow-up of 7 +/- 3.3 years, 37 patients (66%) were successfully treated with dilatation and endoscopically placed stents. One patient died due to a treatment-related complication. A total of 18 patients (32%) underwent a hepaticojejunostomy. Postoperative complications occurred in three patients (5%) without hospital mortality. These data confirm that end-to-end anastomosis might be considered as a primary treatment for peroperative detected transection of the bile duct without extensive tissue loss. Complications (stricture or leakage) can be adequately managed by endoscopic or percutaneous drainage the majority of patients (66%) and reconstructive surgery after complicated end-to-end anastomosis is a procedure with relative low morbidity and no mortality.
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Affiliation(s)
- P. R. de Reuver
- Department of Surgery, Amsterdam Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - O. R. C. Busch
- Department of Surgery, Amsterdam Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - E. A. Rauws
- Department of Gastroenterology, Academic Medical Center, Amsterdam, Netherlands
| | - J. S. Lameris
- Department of Radiology, Academic Medical Center, Amsterdam, Netherlands
| | - Th. M. van Gulik
- Department of Surgery, Amsterdam Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - D. J. Gouma
- Department of Surgery, Amsterdam Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Oncel D, Ozden I, Bilge O, Tekant Y, Acarli K, Alper A, Emre A, Arioğul O. Bile duct injury during cholecystectomy requiring delayed liver transplantation: a case report and literature review. TOHOKU J EXP MED 2006; 209:355-9. [PMID: 16864958 DOI: 10.1620/tjem.209.355] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Major bile duct injury during cholecystectomy represents potentially severe complications with unpredictable long-term results. If these lesions are not treated adequately, they can lead to hepatic failure or secondary biliary cirrhosis therefore requiring liver transplantation. We report a patient who required liver transplantation 15 years after open cholecystectomy. A l0-year old girl underwent open cholecystectomy and duodenal repair for cholelithiasis and cholecystoduodenal fistula. She required two surgical interventions, hepaticojejunostomy which was performed in another center and portoenterostomy for biliary stricture at our institution seven years after the cholecystectomy. Eight years after the third operation, she required recurrent hospitalization for treatment of hepatic abscesses. The extremely short intervals between the three life threatening episodes and the rapid progression to severe sepsis were taken into consideration and liver transplantation was performed at the age of 25. She is leading a healthy life at 4 years post transplantation. Although iatrogenic biliary injury can usually be treated successfully by a combination of surgery, radiological and endoscopic techniques, patients with severe injuries develop irreversible liver disease. This case report and review of the literature suggest that liver transplantation is a treatment modality for a selected group of patients with end-stage liver disease secondary to bile duct injury.
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Affiliation(s)
- Didem Oncel
- Department of General Surgery, Hepatopancreatobiliary Surgery Unit, Istanbul University, Istanbul Faculty of Medicine, Turkey
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Bilge O, Bozkiran S, Ozden I, Tekant Y, Acarli K, Alper A, Emre A, Arioğul O. The effect of concomitant vascular disruption in patients with iatrogenic biliary injuries. Langenbecks Arch Surg 2003; 388:265-9. [PMID: 12774233 DOI: 10.1007/s00423-003-0382-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2003] [Accepted: 05/06/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS To evaluate treatment results in iatrogenic biliary injuries with concomitant vascular injuries. PATIENTS/METHODS Between January 1998 and May 2002 (inclusive), angiography was performed in 45 of the 105 patients treated for iatrogenic biliary tract injury. The charts of these 45 patients and 5 other patients in whom vascular injury was diagnosed at operation were evaluated retrospectively. Twenty-nine patients had concomitant vascular injury, the biliovascular injury group (BVI), and the remaining 21 patients had isolated biliary tract injury (IBTI). RESULTS The most frequent initial operation was a cholecystectomy. The frequency of high-level (Bismuth III or IV) strictures was 90% in the BVI group and 62% in the IBTI group ( P<0.05). Perioperative mortality was 7% in the BVI group and 5% in the IBTI group ( P>0.05). The morbidity in the BVI group was significantly higher ( P<0.05). Two patients in each group were lost to follow up. During a median (range) follow up of 31 months (5-51 months), a successful functional outcome was achieved in 96% of the BVI group and 100% of the IBTI group with a multimodal approach ( P>0.05). CONCLUSIONS The frequency of high-level biliary injury and morbidity were significantly higher in the BVI group. However, concomitant vascular injury had no significant effect on mortality and medium-term outcome of biliary reconstruction. Thus, routine preoperative angiography is not recommended.
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Affiliation(s)
- Orhan Bilge
- Hepatopancreatobiliary Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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