title: Predictors of outcome after reconstructive hepatico-jejunostomy for post cholecystectomy bile duct injuries.
abstract: BACKGROUND
  Reconstructive hepatico-jejunostomy is recommended for major bile duct injuries (BDIs) during cholecystectomy. Complications of biliary leak, cholangitis, bleeding, anastomotic strictures and biliary cirrhosis remain a major concern affecting a patient's outcome after surgery. The aim of this study was to analyse the results of surgical repair of major BDIs at our institution and identify predictors for the development of major complications.
  
  
  METHODS
  A retrospective study of 57 patients with major BDI after cholecystectomy referred to a tertiary hepato-biliary centre from July 1999 to July 2011 and subsequently managed with reconstructive bilio-enteric anastomosis was performed.
  
  
  RESULTS
  Of 57 patents 35 (61.4%) were primary referred. 22 (38.6 %) were secondary referred, of which 17 were for correct reconstructive surgery performed elsewhere and 5 were following attempted endoscopic management. 17 (29.8%) had local and systemic perioperative complications. 13 (22.8%) had major complications (bile leak, bleed, stricture and/or biliary cirrhosis). No association was found between age, type of cholecystectomy, type of injury, vascular injury and occurrence of major complications. Secondarily referred patients after therapeutic interventions (p = 0.010) and reconstructive surgery after repair performed by non-specialists suffered an increased incidence of major complications (p = 0.032). Secondary referral was also an independent predictor of major complications (p = 0.024).
  
  
  CONCLUSIONS
  Early referral of patients with no previous intervention to a tertiary hepato-biliary center and specialist surgical repair is recommended for improved outcome after reconstructive hepatico-jejunostomy for major BDIs during cholecystectomy.
authors: Rachel M
authors: RM
authors: Gomes
authors: Nilesh H
authors: NH
authors: Doctor
mesh_terms: D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000293:injuries / Q000601:surgery*; D001658:Biliary Fistula / Q000209:etiology / Q000601:surgery*; D002763:Cholecystectomy / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006499:Hepatic Artery / Q000293:injuries; D006801:Humans; D007565:Jaundice / Q000209:etiology; D007582:Jejunostomy / Q000379:methods*; D022125:Lacerations; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012017:Referral and Consultation; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult