title: Long-term follow-up of 120 patients after hepaticojejunostomy for treatment of post-cholecystectomy bile duct injuries: A retrospective cohort study.
abstract: BACKGROUND
  Long-term follow-up is essential for assessment of success of the surgical repair of post-cholecystectomy bile duct injuries (BDI). Factors affecting the long-term outcome and satisfactory length of follow-up have been little reported in the literature. The aim of this study is long-term evaluation of hepaticojejunostomy regarding clinical, radiological, laboratory and quality of life assessment.
  
  
  METHODS
  Between January 1992 to December 2007, 120 patients with postcholecystectomy bile duct injury surgically treated by hepaticojejunostomy Roux-en-Y were followed up for 20 years in Mansoura Gastro-enterology Center. Long-term outcomes and quality of life (QOL) were evaluated for all patients. Univariate and multivariate analyses were done for detection of factors affecting long-term outcome.
  
  
  RESULTS
  The median follow up period was 149 months, range (70-246 months). Successful long-term outcome was detected in 106 (88.3%) patients. Long-term complications were detected in 35 (29%) patients. Fourteen (11.6%) patients developed anastomotic stricture within different follow up intervals up to 17 years, of which. Seventeen (14.2%) patients developed recurrent episodes of cholangitis at median interval 48 months, range (2-156 months). Post-ERCP pancreatitis, number of anastomosis, operative time, post-operative early complications, and post-operative bile leak were predictors for poor outcome. Physical component was much more affected than mental component in QOL.
  
  
  CONCLUSIONS
  Management of BDI in specialized centers is highly recommended. Longer time for follow-up of the patients of surgical repair of bile duct injury up to 20 years should be adopted to ensure successful outcome. Quality of life assessment is essential component of long-term follow-up.
authors.affiliation: Gastroenterology Surgical Center (GEC), Department of Surgery, Mansoura University, Egypt. Electronic address: dr_ahmadabdelrafee@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: AbdelRafee
authors.affiliation: Gastroenterology Surgical Center (GEC), Department of Surgery, Mansoura University, Egypt. Electronic address: shobari@yahoo.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Shobari
authors.affiliation: Gastroenterology Surgical Center (GEC), Department of Surgery, Mansoura University, Egypt. Electronic address: waleedaskar55@yahoo.com.
authors.forename: Waleed
authors.initials: W
authors.lastname: Askar
authors.affiliation: Gastroenterology Surgical Center (GEC), Department of Surgery, Mansoura University, Egypt. Electronic address: dr_ahmadsultan@hotmail.com.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Sultan
authors.affiliation: Gastroenterology Surgical Center (GEC), Department of Surgery, Mansoura University, Egypt. Electronic address: elnakeebayman@yahoo.com.
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anastomotic stricture; Bile duct injury; Hepaticojejunostomy