title: Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury.
abstract: OBJECTIVE
  To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular injury.
  
  
  METHODS
  From a prospective database of patients treated for benign biliary strictures at our hospital, cases that underwent liver resections were reviewed. All cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy (open or laparoscopic). Liver resection was indicated in patients with Strasberg E3/E4 (hilar stricture) bile duct lesions associated with vascular damage (arterial and/or portal), ipsilateral liver atrophy/abscess, recurrent attacks of cholangitis, and failure of previous hepaticojejunostomy.
  
  
  RESULTS
  Of 148 patients treated for benign biliary strictures, nine (6.1%) underwent liver resection; eight women and one man with a mean age of 38.6 years. Six patients had previously been submitted to open cholecystectomy and three to laparoscopic surgery. The mean number of surgical procedures before definitive treatment was 2.4. All patients had Strasberg E3/E4 injuries, and vascular injury was present in all cases. Eight patients underwent right hepatectomy and one underwent left lateral sectionectomy without mortality. Mean time of follow up was 69.1 mo and after long-term follow up, eight patients are asymptomatic.
  
  
  CONCLUSIONS
  Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed.
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Marcos V
authors.initials: MV
authors.lastname: Perini
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Andre L
authors.initials: AL
authors.lastname: Montagnini
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Jose
authors.initials: J
authors.lastname: Jukemura
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Fabricio F
authors.initials: FF
authors.lastname: Coelho
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Kruger
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Telesforo
authors.initials: T
authors.lastname: Bacchella
authors.affiliation: Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000328:Adult; D001938:Brazil; D002763:Cholecystectomy / Q000009:adverse effects*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
keywords: Abscess; Atrophy; Benign; Bile ducts; Cholecystectomy; Hepatectomy; Stenosis; Vascular system injury