[Indications of hepatectomy for iatrogenic biliary injury.].
BACKGROUND
The most efficient surgical procedure to treat bile duct injuries is a Roux en Y hepatoyeyunoanastomosis (RY-HYA). A small group of patients who have undergone a RY-HTA develop cholangitis without jaundice, with proven permeability of the anastomosis.


OBJECTIVE
To describe our experience in this subgroup of patients.


METHODS
355 patients received surgical treatment for BDI with a RY-HYA. Medical charts of patients diagnosed with segmentary cholangitis involving a single hepatic lobe were reviewed. Segmentary cholangitis with intra-hepatic abscess was diagnosed through computer tomography, endoscopic retrograde cholangiopancreatography or by percutaneous transhepatic cholangiography.


RESULTS
We found 10 patients with segmentary cholangitis within the 355 cases in our series. Eight of them received treatment with a right hepatectomy and two of them with a left hepatectomy. In every patient, the hepatoyeyunoanastomosis was dismantled during the reoperation, corroborating the presence of a wide and permeable anastomosis. Surgical exploration was conducted through the hepatic ducts. After the affected lobe hepatectomy a new hepatoyeyunoanastomosis was performed. Out of the 10 patients one died (mortality 10%) due to hepatic cirrhosis. In the rest of the group a satisfactory resolution of the segmentary cholangitis was observed.


CONCLUSIONS
In our series, 3% of the patients required a mayor hepatectomy for the persistent cholangitis to resolve, despite the presence of a functional bilioenteric anastomosis. Segmentary cholangitis must be suspected in patients with normal levels of direct bilirubin and abnormal liver function tests with clinical manifestations of cholangitis.
Mercado
M A
MA
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. México, D. F. mercadiazma@yahoo.com
Sánchez
N
N
Ramírez-del Val
F
F
Cerón
R C
RC
Urencio
J M
JM
Domínguez
I
I
D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male