title: Hepatic resection for post-cholecystectomy bile duct injuries: a literature review.
abstract: OBJECTIVE
  This study seeks to identify factors for hepatectomy in the management of post-cholecystectomy bile duct injury (BDI) and outcome via a systematic review of the literature.
  
  
  METHODS
  Relevant literature was found by searching the PubMed database and the bibliographies of extracted articles. To avoid bias selection, factors for hepatectomy were analysed in series reporting both patients undergoing hepatectomy and patients undergoing biliary repair without hepatectomy (bimodal treatment). Relevant variables were the presence or absence of additional hepatic artery and/or portal vein injury, the level of BDI, and a previous biliary repair.
  
  
  RESULTS
  Among 460 potentially relevant publications, only 31 met the eligibility criteria. A total of 99 hepatectomies were reported among 1756 (5.6%) patients referred for post-cholecystectomy BDI. In eight series reporting bimodal treatment, including 232 patients, logistic regression multivariate analysis showed that hepatic arterial and Strasberg E4 and E5 injuries were independent factors associated with hepatectomy. Patients with combined arterial and Strasberg E4 or E5 injury were 43.3 times more likely to undergo hepatectomy (95% confidence interval 8.0-234.2) than patients without complex injury. Despite high postoperative morbidity, mortality rates were comparable with those of hepaticojejunostomy, except in urgent hepatectomies (within 2 weeks; four of nine patients died). Longterm outcome was satisfactory in 12 of 18 patients in the largest series.
  
  
  CONCLUSIONS
  Hepatectomies were performed mainly in patients showing complex concurrent Strasberg E4 or E5 and hepatic arterial injury and provided satisfactory longterm outcomes despite high postoperative morbidity.
authors.affiliation: Department of Digestive Surgery and Transplantation, University Hospitals, Lille, France. s-truant@chru-lille.fr
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Truant
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.forename: Gilles
authors.initials: G
authors.lastname: Lebuffe
authors.forename: Géraldine
authors.initials: G
authors.lastname: Sergent
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
mesh_terms: D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006499:Hepatic Artery / Q000293:injuries / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D016015:Logistic Models; D018579:Patient Selection; D011169:Portal Vein / Q000293:injuries / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery*