title: Long-term consequences of bile duct injury after cholecystectomy.
abstract: Late complications arising after bile duct injury (BDI) include biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis. Secondary biliary cirrhosis resulting in associated hepatic failure or digestive tract bleeding due to portal hypertension is a substantial risk factor for morbidity and mortality after bile duct repair. Parameters that determine the management of late complications of BDI include the type of biliary injury, associated vascular injury, hepatic atrophy, the presence of intra-hepatic strictures or lithiasis, repetitive infectious complications, the quality of underlying parenchyma (fibrosis, secondary biliary cirrhosis) and the presence of portal hypertension. Endoscopic drainage is indicated for patients with uncontrolled acute sepsis, patients at high operative risk, patients with cirrhosis who are not eligible for liver transplantation and patients who have previously undergone several attempts at repair. Roux-en-Y hepaticojejunostomy, whether de novo or as an iterative repair, is the technique of reference for post-cholecystectomy BDI. Hepatic resection is indicated in only rare instances, mainly in case of extended hilar stricture, multiple stone retention in one sector of the liver or in patients for whom the repair is deemed technically difficult. Liver transplantation is indicated only in exceptional circumstances, when secondary biliary cirrhosis is associated with liver failure and portal hypertension.
authors: Chirurgie Digestive et Transplantation Hépatique, Hôpital La Conception, Assistance publique-Hôpitaux de Marseille, Aix-Marseille Université, 147, boulevard Baille, 13385 Marseille cedex 5, France. Electronic address: louisebarbier@hotmail.fr.
authors: L
authors: L
authors: Barbier
authors: Chirurgie Digestive A, Hôpital Saint-Éloi, Centre Hospitalo-Universitaire, Montpellier, France.
authors: R
authors: R
authors: Souche
authors: Service de Chirurgie Digestive, Unité de Chirurgie Ambulatoire, CHU Estaing, Clermont-Ferrand, France.
authors: K
authors: K
authors: Slim
authors: Gastro-Entérologie et Hépatologie, Centre Hospitalier Régional de Toulon, Toulon, France.
authors: P
authors: P
authors: Ah-Soune
mesh_terms: D001652:Bile Ducts / Q000293:injuries*; D002761:Cholangitis / Q000209:etiology / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D002779:Cholestasis / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D008105:Liver Cirrhosis, Biliary / Q000209:etiology* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D011788:Quality of Life; D012086:Reoperation; D018570:Risk Assessment; D013997:Time Factors
keywords: Bile duct injury; Cholecystectomy; Secondary biliary cirrhosis