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Giuliante F, Panettieri E, De Rose AM, Murazio M, Vellone M, Mele C, Clemente G, Giovannini I, Nuzzo G, Ardito F. Bile duct injury after cholecystectomy: timing of surgical repair should be based on clinical presentation. The experience of a tertiary referral center with Hepp-Couinaud hepatico-jejunostomy. Updates Surg 2023; 75:1509-1517. [PMID: 37580549 PMCID: PMC10435431 DOI: 10.1007/s13304-023-01611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Impact of timing of repair on outcomes of patients repaired with Hepp-Couinaud hepatico-jejunostomy (HC-HJ) after bile duct injury (BDI) during cholecystectomy remains debated. This is an observational retrospective study at a tertiary referral hepato-biliary center. HC-HJ was always performed in patients without sepsis or bile leak and with dilated bile ducts. Timing of repair was classified as: early (≤ 2 weeks), intermediate (> 2 weeks, ≤ 6 weeks), and delayed (> 6 weeks). 114 patients underwent HC-HJ between 1994 and 2022: 42.1% underwent previous attempts of repair at referring institutions (Group A) and 57.9% were referred without any attempt of repair before referral (Group B). Overall, a delayed HC-HJ was performed in 78% of patients; intermediate and early repair were performed in 17% and 6%, respectively. In Group B, 10.6% of patients underwent an early, 27.3% an intermediate, and 62.1% a delayed repair. Postoperative mortality was nil. Median follow-up was 106.7 months. Overall primary patency (PP) attainment rate was 94.7%, with a 5- and 10-year actuarial primary patency (APP) of 84.6% and 84%, respectively. Post-repair bile leak was associated with PP loss in the entire population (odds ratio [OR] 9.75, 95% confidence interval [CI] 1.64-57.87, p = 0.012); no correlation of PP loss with timing of repair was noted. Treatment of anastomotic stricture (occurred in 15.3% of patients) was performed with percutaneous treatment, achieving absence of biliary symptoms in 93% and 91% of cases at 5 and 10 years, respectively. BDI can be successfully repaired by HC-HJ regardless of timing when surgery is performed in stable patients with dilated bile ducts and without bile leak.
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Affiliation(s)
- Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Agostino M De Rose
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Marino Murazio
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Maria Vellone
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Caterina Mele
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Gennaro Clemente
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Ivo Giovannini
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Gennaro Nuzzo
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
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Martínez-Mier G, Moreno-Ley PI, Esquivel-Torres S, Gonzalez-Grajeda JL, Mendez-Rico D. Differences in Post-Cholecystectomy Bile Duct Injury Care: A Comparative Analysis of 2 Different Health-Care Public Institutions in a Low- and Middle-Income Country: Southeast Mexico. Dig Surg 2020; 37:472-479. [PMID: 32829340 DOI: 10.1159/000509706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/23/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND Mexican health system structure allows us to study the differences in bile duct injury (BDI) management. The study aimed to assess the differences in patients with complex BDI in 2 different public sector institutions using a new proposed standard terminology. METHODS Retrospective review (2008-2019) in 2 public institutions (IMSS/SESVER). Bismuth-Strasberg E injuries with hepaticojejunostomy were included. Data are presented in a tabular reporting system. The outcomes were percent of patients attaining primary patency, loss of primary patency, and actuarial primary patency rate. RESULTS Seventy-eight patients (IMSS: n = 37; SESVER: n = 41) without differences in demographic and preoperative assessment were studied. BDI occurred mostly in outside hospitals. Open cholecystectomy was the most common index operation in SESVER (73%, p = 0.02). IMSS had more surgeries (p = 0.007) and repair attempts (p = 0.06) prior to referral. Magnetic resonance cholangiopancreatography was more commonly used in IMSS patients. Biliary stents (45%) and cholangitis (29%) were more common in IMSS (p < 0.05). IMSS patients had longer follow-up than SESVER (p < 0.05). No differences in primary patency rates (IMSS: 89%, SESVER: 97%) and actuarial patency rates were noted. DISCUSSION Despite differences in referral, preoperative, and operative events, good BDI repair outcomes can be achieved. Longer follow-up is needed to monitor these outcomes.
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Affiliation(s)
- Gustavo Martínez-Mier
- Organ Transplantation and General Surgery, IMSS UMAE Hospital de Especialidades, Veracruz, Mexico, .,Organ Transplantation and General Surgery, SESVER Hospital de Alta Especialidad "Virgilio Uribe", Veracruz, Mexico,
| | - Pedro Ivan Moreno-Ley
- Organ Transplantation and General Surgery, IMSS UMAE Hospital de Especialidades, Veracruz, Mexico.,Organ Transplantation and General Surgery, SESVER Hospital de Alta Especialidad "Virgilio Uribe", Veracruz, Mexico
| | - Sergio Esquivel-Torres
- Surgical Oncology, SESVER Hospital de Alta Especialidad "Virgilio Uribe", Veracruz, Mexico
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