[Iatrogenic injury of the bile duct. Experience with repair in 180 patients].
OBJECTIVE
Biliary duct lesions have a prevalence of 0.3-0.6% This prevalence is independent of the learning curve: The present paper evaluated survival and quality of life of patients following operative repair.


METHODS
In a 12-year period, 180 patients underwent bile duct reconstruction. Of these patients (61 males and 129 females, mean age 39 years), 52% sustained injury during open operation and 42% during laparoscopic procedure. Quality of life was evaluated in the postoperative period.


RESULTS
All 180 patients were treated surgically by means of Roux en Y hepaticojejunostomy. Transhepatic stents were used in 142 patients. Eight patients had independent left and right duct anastomosis and in 51 cases, partial resection of segment IV of liver to improve exposure of hilus was carried out. Mortality was 1.7%, due to multiorganic failure. After removal of stent, radiologic manipulation was required in 16% of cases to remove debris and stones or to dilate anastomosis. A total of 83% of patients were completely rehabilitated both clinically and biochemically.


CONCLUSIONS
Bile duct injury has a good prognosis in specialized tertiary-care centers. Roux en Y hepatoyeyunostomy is procedure of choice with trans-hepatic stent when needed. Full rehabilitation can be achieved in 80% of patients.
Mercado
Miguel Angel
MA
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan, 14000, México, D.F.
Chan
Carlos
C
Tielve
Manuel
M
Contreras
Alan
A
Gálvez-Treviño
Raúl
R
Ramos-Gallardo
Guillermo
G
Orozco
Héctor
H
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life