Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures.
OBJECTIVE
To compare the clinical presentation and results of treatment of postcholecystectomy bile duct injuries in patients with and without arterial injuries.


BACKGROUND
Incidence and impact of arterial injuries in patients with a postcholecystectomy biliary injury are unknown, although they are claimed to increase the risk of septic complications, difficulty of biliary repair and risk of recurrent stricture.


METHODS
Fifty-five patients referred for postcholecystectomy biliary strictures and who underwent surgical repair were prospectively evaluated by celiac and superior mesenteric angiography. Circumstance and presenting symptoms of the biliary injury in patients with and without vascular injury as well as intra- and postoperative outcome in the 43 patients who underwent a Hepp-Couinaud biliary repair were compared.


RESULTS
Incidence of vascular injury was 47%, the most frequent of which was right-sided hepatic artery disruptions (36%). Indication of cholecystectomy (cholecystitis, 42 vs. 45%), technique of resection (laparoscopy, 80 vs. 79%) as well as delay of recognition and presenting symptom of the biliary injury were comparable in patients with and without vascular injury. Among patients undergoing a biliary repair, the level of the biliary injury (Bismuth's type III or IV 63% vs. 54%), duration of surgery, and incidence of postoperative complications (21 vs. 21%) were also comparable in patients with and without arterial injury. One patient in each group experienced recurrent biliary stricture.


CONCLUSIONS
The discovery of a disruption of the right branch of the hepatic artery should not affect management of the biliary stricture when if a Hepp-Couinaud repair is performed.
Alves
Arnaud
A
Department of Surgery, Hospital Beaujon, AP-Hôpitaux de Paris, University Paris VII, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex, France.
Farges
Olivier
O
Nicolet
Jérôme
J
Watrin
Thierry
T
Sauvanet
Alain
A
Belghiti
Jacques
J
D000328:Adult; D000368:Aged; D000792:Angiography; D001652:Bile Ducts / Q000293:injuries*; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D001651:Cholestasis, Extrahepatic / Q000209:etiology* / Q000601:surgery; D003251:Constriction, Pathologic; D005260:Female; D006499:Hepatic Artery / Q000293:injuries*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*