title: Surgical management and outcome of bile duct injuries following cholecystectomy: a single-center experience.
abstract: OBJECTIVE
  Biliary injury is a severe complication of cholecystectomy. The Hepp-Couinaud reconstruction with the hepatic duct confluence and the left duct may offer best long-term outcome as long as the confluence remains intact (Bismuth I-III). Complex liver surgery is usually indicated in most proximal (Bismuth IV) injuries in non-cirrhotic patients. The aim of this study was to evaluate the surgical treatment and outcome of bile duct injuries managed in a referral hepatobiliary unit.
  
  
  METHODS
  We retrospectively analyzed surgical management and outcome of biliary injuries following cholecystectomy in 35 patients (27 laparoscopic) referred to our center between June 2001 and December 2009. There was no liver cirrhosis diagnosed in any patient. High injuries (Bismuth III-IV) were found in 14 patients. Management after referral included the Hepp-Couinaud hepaticojejunostomy in 32 patients with Bismuth I-III injuries, which in four cases with biliary peritonitis was preceded by abdominal lavage and prolonged external biliary drainage. Liver transplantation was performed in two patients with Bismuth IV injuries.
  
  
  RESULTS
  After median follow-up of 59 months (range, 6-102), 34 (97%) patients are alive and 32 (92%) remain in good general condition with normal liver function. One patient who had combined biliary and colonic injury died of sepsis before repair. Recurrent strictures following the Hepp-Couinaud repair developed in two (6%) patients with high injuries combined with right hepatic arterial injury.
  
  
  CONCLUSIONS
  The Hepp-Couinaud hepaticojejunostomy offers durable results, even after previous interventions have failed. In case of diffuse biliary peritonitis, delayed biliary reconstruction following external biliary drainage may be the best option.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Marie Curie Hospital, ul. Arkonska 4, 71-455, Szczecin, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Lubikowski
authors.forename: Mariola
authors.initials: M
authors.lastname: Post
authors.forename: Andrzej
authors.initials: A
authors.lastname: Białek
authors.forename: Janusz
authors.initials: J
authors.lastname: Kordowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Milkiewicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Wójcicki
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006500:Hepatic Duct, Common / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D007582:Jejunostomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012017:Referral and Consultation; D012086:Reoperation; D012189:Retrospective Studies