Long-term results of large diameter hepaticojejunostomy for treatment of Bile Duct Injuries following cholecystectomy.
OBJECTIVE
Bile Duct Injury (BDI) is one of the most serious complications of cholecystectomy. The authors analyzed the clinical presentation, surgical management and long-term outcome of 19 patients presenting with iatrogenic major BDIs (Straburg type E) following cholecystectomy who underwent Roux-en-Y hepaticojejunostomy.


METHODS
Between 1992 and 2005, 19 patients with major BDIs (Strasberg type E) following cholecystectomy were included. Operative notes and charts of all patients were reviewed systematically. A follow-up examination of each patient was performed after a median of 22 months (range 1-120).


RESULTS
Twelve patients presented with ascending cholangitis, two patients were referred to the hospital with biliary-cutaneous fistula and five patients (26.3%) were identified at the time of operations. All patients were treated with Roux-en-Y hepaticojejunostomy with at least 2 cm of the diameter of the biliary-enteric anastomosis. There was no postoperative mortality. Postoperative complication was found in 5 patients (26.3%). Until now, during the follow-up, neither clinical nor biochemical evidence of recurrent cholangitis has been found.


CONCLUSIONS
Major BDIs are associated with high morbidity rate and prolonged hospitalization. Early detection and referral to an experienced center is crucial in the management of these patients. Roux-en-Y hepaticojejunostomy with large diameter of the biliary-enteric anastomosis is the surgical procedure of choice with good long-term outcome.
Akaraviputh
T
T
Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sitak@mahidol.ac.th
Boonnuch
W
W
Lohsiriwat
V
V
Methasate
A
A
Chinswangwatanakul
V
V
Lert-akayamanee
N
N
Lohsiriwat
D
D
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D002763:Cholecystectomy / Q000009:adverse effects*; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications