Results of surgical treatment of extrahepatic bile duct injuries

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Abstract

Aim. To evaluate the short-and long-term outcomes after surgical repair of iatrogenic lesions of extrahepatic bile ducts depending on the timing of diagnosis in conditions of specialized clinic.

Materials and methods. Our study involved a retrospective analysis of 159 patients who were treated for iatrogenic lesions of extrahepatic bile ducts during 1987-2017. These patients were divided into two groups depending on the timing of surgical treatments: early biliary reconstruction (< 5 days after bile duct transection) and late biliary reconstruction (> 5 days post-transection). These groups were compared on the basis of postoperative morbidity and long-term outcomes.

Results. Following laparoscopic cholecystectomy, 2 patients received endoscopic retrograde stents due to bile leakage from the cystic ducts, and 14 patients underwent hepaticocholedochostomy using Ker drainage. The incidence of bile leakage was observed in 14. 3 % of cases during the early post-operative period, strictures appeared in 28.6 % of cases. Hepaticojejunostomy was performed in 91 cases: in 62 – with stents and in 29 – without stents. Bile leakage was observed in 17.6 % of cases, and strictures – in 19.8 % of cases. Our statistical analyses revealed no significant differences between the two groups (i.e., early and late timing of surgical treatment) in the rates of bile leakage and strictures. The extent of surgeon’s experience in bile surgery significantly correlated with positive outcomes.

Conclusions. Endoscopic retrograde stent proved to be an effective and fast solution in cases of bile leakage from cystic ducts following laparoscopic cholecystectomy. Although it is preferable to perform reconstructive surgeries within the first five days after bile duct injury, our results indicated that in the presence of external bile fistula without peritonitis and severe cholangitis, reconstructive surgery can be performed in specialized surgical departments later than 5 days with satisfactory results.

About the authors

L. P. Kotelnikova

E.A. Vagner Perm State Medical University; Perm Regional Clinical Hospital

Author for correspondence.
Email: splaksin@mail.ru

доктор медицинских наук, профессор, заведующая кафедрой хирургии с курсом сердечно-сосудистой хирургии и инвазивной кардиологии

Russian Federation, Perm

I. G. Burnyshev

E.A. Vagner Perm State Medical University; Perm Regional Clinical Hospital

Email: nfperm@mail.ru

кандидат медицинских наук, заведую­щий 2-м хирургическим отделением

Russian Federation, Perm

O. V. Bazhenova

Perm Regional Hospital

Email: katrina280@yandex.ru

врач-хирург

Russian Federation, v. Kultaevo

D. V. Trushnikov

Perm Regional Clinical Hospital

Email: hir.fpk159@yandex.ru

врач-­эндоскопист

Russian Federation, Perm

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2. Fig. 1. Patient F., 80 years old. ERCP: a - leakage of contrast from the stump of the cystic duct; b - stent 10 Fr, length 9 cm, held in the common hepatic duct

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3. Fig. 2. MRI cholangiography. Patient D., 45 years old. The intersection of the common hepatic duct at the level of confluence. The total hepatic duct is absent over 35 mm. Control drainage in the subhepatic space. No accumulation of fluid in the abdomen

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Copyright (c) 2020 Kotelnikova L.P., Burnyshev I.G., Bazhenova O.V., Trushnikov D.V.

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