title: Reconstruction of major bile duct injuries after laparoscopic cholecystectomy.
abstract: BACKGROUND
  Bile duct injury (BDI) after cholecystectomy remains a serious complication with major implications for patient outcome. For most major BDIs, the recommended method of repair is a hepaticojejunostomy (HJ). We conducted a retrospective review aiming to examine the perioperative and the long-term outcome after reconstructive HJ at our institution.
  
  
  METHODS
  Retrospective review of 41 consecutive patients with BDI sustained during cholecystectomy and subsequently managed with a HJ. The patients were referred to a tertiary hepato-biliary centre during a 15-year period (1994-2008).
  
  
  RESULTS
  A total of 32 cases (78%) were reconstructed within two weeks of injury. While 14 patients (34%) suffered perioperative complications, 22 patients (54%) had a complication-free short as well as long-term outcome. Within a median follow-up period of 9.2 years, ten patients (24%) developed biliary strictures requiring percutaneous dilatation and/or further surgery. Three patients had further segmental hepatectomies and one patient developed secondary biliary cirrhosis necessitating orthotopic liver transplantation. No association was found between timing of repair or level of injury and outcome.
  
  
  CONCLUSIONS
  Early specialist repair may result in acceptable short as well as long-term outcome; however, the morbidity of reconstructive biliary surgery remains high--particularly in the context of patient expectations before laparoscopic cholecystectomy.
authors.affiliation: Rigshospitalet, Department of Surgery and Transplantation. kathrine.holte@dadlnet.dk
authors.forename: Kathrine
authors.initials: K
authors.lastname: Holte
authors.forename: Linda
authors.initials: L
authors.lastname: Bardram
authors.forename: André
authors.initials: A
authors.lastname: Wettergren
authors.forename: Allan
authors.initials: A
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult