title: Biliary cirrhosis and sepsis are two risk factors of failure after surgical repair of major bile duct injury post-laparoscopic cholecystectomy.
abstract: BACKGROUND
  Major bile duct injury (MBDI) remains frequent after laparoscopic cholecystectomy (LC) reaching 0.3 to 0.6 % and is associated with a significant mortality rate. The aim of this study was to retrospectively analyze the factors likely to influence the long-term results of surgical repair for MBDI occurring after LC.
  
  
  METHODS
  Medical records of patients referred to our referral center from January 1992 to January 2010 for management of bile duct injury following LC were retrospectively analyzed, and patients with MBDI were identified. Clinicopathological factors likely to influence long-term results after surgical repair were assessed by univariate and multivariable analysis.
  
  
  RESULTS
  During the study period, 38 patients were treated for MBDI. These 38 patients underwent Roux-en-Y hepaticojejunostomy (HJ) or HJ revision in 25 (66 %) and 13 (34 %) cases, respectively. The median follow-up period was 93 (26-204) months. A Clavien-Dindo post-operative morbidity class >3 occurred in 10 (26 %) cases and was independently associated with a surgical repair performed during a sepsis period (OR = 102.5; IC 95 % [7.12; 11,352], p < 0.007). Long-term results showed that biliary strictures occurred in 5 (13 %) cases and were associated with sepsis (p < 0.006), liver cirrhosis (p < 0.002) and post-operative complications (p < 0.012). Multivariate analysis revealed that only liver cirrhosis remained predictive of stricture (OR = 26.4, 95 % CI [2; 1,018], p < 0.026).
  
  
  CONCLUSIONS
  When MBDI occurs following LC, HJ seems to be the optimal treatment but should not be performed during a sepsis period. Long-term results are significantly altered by the presence of a biliary cirrhosis at time of repair.
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France, laurent.sulpice@chu-rennes.fr.
authors.forename: L
authors.initials: L
authors.lastname: Sulpice
authors.forename: S
authors.initials: S
authors.lastname: Garnier
authors.forename: M
authors.initials: M
authors.lastname: Rayar
authors.forename: B
authors.initials: B
authors.lastname: Meunier
authors.forename: K
authors.initials: K
authors.lastname: Boudjema
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002423:Cause of Death; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008105:Liver Cirrhosis, Biliary / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome