title: Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study.
abstract: BACKGROUND
  The aim of this retrospective study was to evaluate the peri-operative and long-term outcome after early repair with a hepaticojejunostomy (HJ).
  
  
  METHODS
  Between 1995 and 2010, a nationwide, retrospective multi-centre study was conducted. All iatrogenic bile duct injury (BDI) sustained during a cholecystectomy and repaired with HJ in the five Hepato-Pancreatico-Biliary centres in Denmark were included.
  
  
  RESULTS
  In total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Post-operative morbidity was 36% and mortality was 4%. Forty-two patients (30%) had a stricture of the HJ. The median follow-up time without stricture was 102 months. Nineteen out of the 42 patients with post-reconstruction biliary strictures had a re-HJ. Twenty-three patients were managed with percutaneous transhepatic cholangiography and dilation. The overall success rate of re-establishing the biliodigestive flow approached 93%. No association was found between timing of repair, concomitant vascular injury, level of injury and stricture formation.
  
  
  CONCLUSIONS
  In this national, unselected and consecutive cohort of patients with BDI repaired by early HJ we found a considerable risk of long-term complications (e.g. 30% stricture rate) and mortality in both the short- and the long-term perspective.
authors.affiliation: Department of Surgery, Odense University Hospital, Odense C, Denmark.
authors.forename: Nicolaj M
authors.initials: NM
authors.lastname: Stilling
authors.forename: Claus
authors.initials: C
authors.lastname: Fristrup
authors.forename: André
authors.initials: A
authors.lastname: Wettergren
authors.forename: Arnas
authors.initials: A
authors.lastname: Ugianskis
authors.forename: Jacob
authors.initials: J
authors.lastname: Nygaard
authors.forename: Kathrine
authors.initials: K
authors.lastname: Holte
authors.forename: Linda
authors.initials: L
authors.lastname: Bardram
authors.forename: Mogens
authors.initials: M
authors.lastname: Sall
authors.forename: Michael B
authors.initials: MB
authors.lastname: Mortensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography; D002763:Cholecystectomy / Q000009:adverse effects*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult