title: Major liver resection as definitive treatment in post-cholecystectomy common bile duct injuries.
abstract: BACKGROUND
  Common bile duct injuries (CBDI) are serious complications of cholecystectomies which are often associated with vascular involvement, meaning that their management represents a major challenge to the physician. We present our experience in major hepatectomy due to CBDI, highlighting indications, postoperative complications, and long-term outcomes.
  
  
  METHODS
  From August 1993 to September 2013, 287 patients with CBDI were treated in our centre. In 15 patients of this group (5 %), a major hepatectomy was performed. Eleven patients presented E4 and four presented E5 injuries of Strasberg classification. Seven patients presented vascular involvement. In 12 patients, prior treatment attempts, either biliodigestive anastomosis, endoscopic or percutaneous drainage, was performed without success. The median time delay between lesional surgery and hepatectomy was 24 months.
  
  
  RESULTS
  Right hepatectomy was performed in 10 patients and left hepatectomy in 5. Postoperative morbidity was 60 %. The incidence of serious complications (≥ grade IIIa of DC classification) was 40 %. There was no mortality in our study. The mean follow-up was 43.5 months and the overall survival was 100 %. Three patients had a single episode of ascendant cholangitis who were successfully treated with medical treatment. All other patients were asymptomatic during follow-up. No patients required further surgical procedures.
  
  
  CONCLUSIONS
  In our series, major hepatectomy due to CBDI was a successful treatment with high rates of postoperative morbidity and excellent long-term outcomes which require a multidisciplinary approach in referral centres of HPB surgery.
authors.affiliation: HPB Surgery and Liver Transplant, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina, juan.pekolj@hospitalitaliano.org.ar.
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.forename: Alejandro
authors.initials: A
authors.lastname: Yanzón
authors.forename: Agustin
authors.initials: A
authors.lastname: Dietrich
authors.forename: Gabriela
authors.initials: G
authors.lastname: Del Valle
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000209:etiology / Q000601:surgery; D001649:Bile Duct Diseases / Q000209:etiology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001808:Blood Vessels / Q000293:injuries; D002761:Cholangitis / Q000209:etiology; D002763:Cholecystectomy / Q000009:adverse effects*; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000601:surgery; D003135:Common Bile Duct / Q000293:injuries*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D015996:Survival Rate