title: Reoperative surgery after repair of postcholecystectomy bile duct injuries: is it worthwhile?
abstract: BACKGROUND
  Repeat repair of bile duct injuries (BDIs) after cholecystectomy is technically challenging, and its success remains uncertain. We retrospectively evaluated the short- and long-term outcomes of patients requiring reoperative surgery for BDI at a major referral center for hepatobiliary surgery.
  
  
  METHODS
  Between January 1991 and May 2011, we performed surgical BDI repairs in 46 patients. Among them, 22 patients had undergone a previous surgical repair elsewhere (group 1), and 24 patients had no previous repair (group 2). We compared the early and late outcomes in the two groups.
  
  
  RESULTS
  The patients in group 1 were younger (48.6 vs. 54.8 years, p = 0.0001) and were referred after a longer interval (>1 month) from BDI (72.7 vs. 41.7%, p = 0.042). Intraoperative diagnosis of BDI (59.1 vs. 12.5%, p = 0.001), ongoing cholangitis (45.4 vs. 12.5%; p = 0.02), and delay of repair after referral to our institution (116 ± 34 days vs. 23 ± 9 days; p = 0.001) were significantly more frequent in group 1 than in group 2. No significant differences were found for postoperative mortality, morbidity, or length of stay between the groups. Patients with associated vascular injuries had a higher postoperative morbidity rate (p = 0.01) and associated hepatectomy rate (p = 0.045). After a mean follow-up of 96.6 ± 9.7 months (range 5-237.2 months, median 96 months), the rate of recurrent cholangitis (6.5%) was comparable in the two groups.
  
  
  CONCLUSIONS
  This study demonstrates that short- and long-term outcomes after surgical repair of BDI are comparable regardless of whether the patient requires reoperative surgery for a failed primary repair. Associated vascular injuries increase postoperative morbidity and the need for liver resection.
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Moliere, 67098, Strasbourg, France.
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Elie
authors.initials: E
authors.lastname: Oussoultzoglou
authors.forename: Pascal
authors.initials: P
authors.lastname: Fuchshuber
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosso
authors.forename: Cinzia
authors.initials: C
authors.lastname: Nobili
authors.forename: Regis
authors.initials: R
authors.lastname: Souche
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome