title: Prognostic implications of preserved bile duct confluence after iatrogenic injury.
abstract: OBJECTIVE
  Biliary reconstruction is performed according to the level of the injury. A comparative study between patients in whom the biliary junction was preserved and another group where the biliary junction was not preserved was done.
  
  
  METHODS
  A retrospective review of the biliary reconstructions performed at our institution after iatrogenic lesions between 1990-2002 was done. Postoperative outcome, functional status of the anastomosis, recurrent cholangitis, need for radiological instrumentation and/or reoperation were analyzed.
  
  
  RESULTS
  We reviewed 204 cases, 130 cases had a preserved biliary junction while in 74 the injury included the junction. All patients were treated with a Roux-en-Y hepatojejunostomy. In the first group, 4% required reoperation, 4% underwent radiological percutaneous instrumentation, 8% had anastomotic dysfunction and 4% cholangitis. In the second group, 24% needed reoperation and 80% radiological instrumentation. Anastomotic dysfunction was observed in 64% and cholangitis in 55%. It is important to note that 52 of the 74 cases in the second group had a history of more than two reconstruction attempts.
  
  
  CONCLUSIONS
  When the biliary junction is preserved after a iatrogenic injury we found a significantly better outcome. The results of biliary reconstruction in this type of patient are better long-term compared to those where the junction was not preserved, evidenced by a lower reoperation and radiological instrumentation rate.
authors.affiliation: Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, DF. mercadiazma@yahoo.com
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Mercado
authors.forename: Carlos
authors.initials: C
authors.lastname: Chan
authors.forename: Héctor
authors.initials: H
authors.lastname: Orozco
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Hinojosa
authors.forename: Eitan
authors.initials: E
authors.lastname: Podgaetz
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ramos-Gallardo
authors.forename: Raul
authors.initials: R
authors.lastname: Gálvez-Treviño
authors.forename: Magdalena
authors.initials: M
authors.lastname: Valdés-Villarreal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000293:injuries* / Q000503:physiopathology* / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007582:Jejunostomy; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015599:Trauma Severity Indices