title: Major hepatectomy for the treatment of complex bile duct injury.
abstract: BACKGROUND
  Postcholecystectomy complex bile duct injuries involving the hilar confluence, which are often associated with vascular injuries and liver atrophy, remain a considerable surgical challenge. The aim of this study is to report our experience of major hepatectomy with long-term outcome in these patients.
  
  
  METHODS
  From January 1987 to January 2002, 18 patients underwent a major hepatectomy for complex bile duct injuries. The hilar confluence was involved in all cases and was associated with vascular injuries in 13 (72%), including arterial injuries in 11, and partial liver atrophy in 15 (83%). The average time interval between the initial cholecystectomy and hepatectomy was 43 +/- 63 months and 16 (88%) patients had previously undergone an average of 2 (range 1-3) surgical repairs.
  
  
  RESULTS
  Major liver resection included a right hepatectomy in 14 (78%) patients, a left hepatectomy in 3, and a left trisectionectomy in one. There was no postoperative mortality, but severe postoperative morbidity was experienced in 11 (61%) patients, including biliary fistula in 7 (39%), prolonged ascites in 8 (44%) and hemorrhage requiring reoperation in one. With a median follow-up time of 8 years (range 3 to 12), 17 (94%) patients have excellent or good results, including 13 patients without symptoms.
  
  
  CONCLUSIONS
  This study shows that salvage major hepatectomy is an efficient treatment for patients with complex hilar bile duct injuries and should be considered before liver transplantation or recourse to metallic stents.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hospital Beaujon-University Denis Diderot Paris 7, Assistance Publique - Hôpitaux de Paris, Clichy, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
authors.forename: Thierry
authors.initials: T
authors.lastname: Watrin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rivkine
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents; D016896:Treatment Outcome