This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Long‐term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. BJS 2005; 92: 76-82.
Published: 1st November 2004
Authors: S. C. Schmidt, J. M. Langrehr, R. E. Hintze, P. Neuhaus
Background
Major bile duct injuries usually need operative repair and remain a challenge even for surgeons who specialize in hepatobiliary surgery. The purpose of this study was to evaluate management and short‐ and long‐term outcomes of patients with major complications after cholecystectomy.
Method
Data were analysed for 54 patients who underwent operation for major bile duct injuries after cholecystectomy between January 1990 and January 2002. Univariate and multivariate analyses were performed to identify risk factors for the development of biliary complications.
Results
Complete follow‐up data were available for all 54 patients (median duration 61·9 (range 2·6–154·3) months). All underwent Roux‐en‐$fontss=cmss10 scaled 1000 hbox{ss Y}$ hepaticojejunostomy. Three patients (6 per cent) died from biliary tract complications during follow‐up. Long‐term biliary complications occurred in ten patients (19 per cent). Nine patients developed biliary stricture of whom five developed secondary biliary cirrhosis. A successful long‐term result was achieved in 50 (93 per cent) of 54 patients, including those who required subsequent procedures. Biliary reconstruction in the presence of peritonitis (P = 0·002), combined vascular and bile duct injuries (P = 0·029), and injury at or above the level of the biliary bifurcation (P = 0·012) were significant independent predictors of poor outcome.
Conclusion
Successful repair of bile duct injuries after cholecystectomy can be achieved in specialized hepatobiliary units. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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