Low serum albumin is not a contraindication for early iatrogenic bile duct injury repair.
Most iatrogenic bile duct injuries are recognized in the early postoperative period (first 48 hours). These patients usually have additional complications such as a suboptimal hydroelectrolitic status, subhepatic collections, external biliary fistula and malnutrition. In these circumstances, besides the elevation of bilirubin and transaminases associated with the injury, hypoalbuminemia is frequently encountered. The timing for repair is decided according to the condition of each patient. We report the impact of preoperative abnormal low serum albumin levels on the results of biliary tract reconstruction after a iatrogenic biliary lesion.


METHODS
Patients who underwent biliary reconstruction in our center from 1998 to 2002 were analyzed. Only patients with complex injuries (Strasberg E, Bismuth III-IV, Stewart-Way III) were included. Major postoperative complications were recorded and correlated with preoperative liver function tests.


RESULTS
Seventy seven patients were analyzed. In 41 cases, the injury was a consequence of a laparoscopic operation. All patients were treated by a Roux-en-Y hepatojejunostomy. No operative mortality was recorded. The most frequent postoperative complications were postoperative biliary fistula (8/77-9%, p < 0.017) and subhepatic collections (9/77-9%, p < 0.39). All fistulae closed spontaneously and the subhepatic collections were drained. Overall, complications were more common in the group with hypoalbuminemia (p < 0.002).


CONCLUSIONS
Early repair is indicated if there is no systemic contraindication (sepsis, multiple organic failure, electrolytic imbalance). Abnormalities in the liver function tests, particularly a low serum albumin, should not delay the operation. Although significantly more postoperative complications are observed in an early repair, long-term results are comparable to those of an elective repair.
Mercado
Miguel Angel
MA
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. mercadiazma@yahoo.com
Chan
Carlos
C
Orozco
Héctor
H
Podgaetz
Eitan
E
Porras-Aguilar
David Estuardo
DE
De la Medina
Antonio Ramos
AR
Hinojosa
Carlos A
CA
Plata-Muñoz
Juan José
JJ
Jaramillo
César
C
Oki
F I
FI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001652:Bile Ducts / Q000293:injuries*; D001658:Biliary Fistula / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D001660:Biliary Tract Diseases / Q000601:surgery*; D000075202:Contraindications; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D012086:Reoperation; D012709:Serum Albumin
D012709:Serum Albumin