Role of Liver Transplantation in Bilio-Vascular Liver Injury After Cholecystectomy.
BACKGROUND
The aim of this study was to report 2 cases of liver transplantation (LT) for iatrogenic bile-vascular injury (BVI) sustained during cholecystectomy and to review the literature for LT after cholecystectomy.


METHODS
Between March 2001 and July 2013, within our institution, 12 patients were treated after cholecystectomy, 3 of 12 received LT, 1 for acute de-compensation in a cirrhotic patient and 2 after iatrogenic lesions.


RESULTS
The majority of iatrogenic injury occurred during video-laparocholecystectomy (63,6%; 7/11). Three patients of 12 (25%) received LT: the first patient developed acute de-compensation in chronic and after liver failure. The second patient developed recurrent cholangitis and secondary biliary cirrhosis. The third patient had undergone emergency hepatectomy because of bleeding and subsequent total hepatectomy with porto-caval shunt. Five of 12 (42%) patients were treated with bilio-digestive anastomosis: 1 patient with direct repair on T-tube; 2 patients (17%) with arterial vascular lesion requiring surgical treatment; and 1 patient treated with medical therapy. No deaths occurred. The post-operative morbidity included 1 re-intervention, 3 recurrent cholangitis, 1 anastomotic biliary stricture, 1 anastomotic bile leak, and cholestasis in 3 patients. The overall hospital stays were higher after LT. Median follow-up was 8.25 years (range, 2-14).


CONCLUSIONS
The management of iatrogenic injury during cholecystectomy depends on the time of recognition, extent of injury, experience of the surgeon, and the patient's general condition. If safe repair is possible, BVI should be treated promptly, otherwise all patients should be treated in an experienced center.
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy. Electronic address: irene.leale@libero.it.
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I
Leale
Emergency Department, IRCCS San Martino-IST, Genoa, Italy.
E
E
Moraglia
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
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G
Bottino
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
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M
Rachef
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
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L
Dova
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
A
A
Cariati
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
A
A
De Negri
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
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P
Diviacco
HBP Surgery and Liver Transplant, IRCCS San Martino-IST, Genoa, Italy.
E
E
Andorno
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002779:Cholestasis / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies