Bile duct injury repair — earlier is not better

Abstract

Bile duct injury is a common complication of cholecystectomy. The timing of bile duct injury repair remains controversial. A recent review conducted in France reported 39% complications and 64% failure after immediate repair in 194 patients compared with 14% complications and 8% failure after late repair in 133 patients. A national review of 139 consecutive early repairs conducted at five hepatopancreaticobiliary centers in Denmark reported 4% mortality, 36% morbidity, and 42 restrictures (30%) at a median follow-up of 102 months, and only 64 patients (46%) demonstrated uneventful short-term and long-term outcomes. Most patients with bile duct injury present with bile leak and sepsis; thus, early repair is not recommended. Percutaneous drainage of bile and endoscopic stenting are the mainstays of treatment of bile leak because they convert acute bile duct injury into a controlled external biliary fistula. The ensuing benign biliary stricture should be repaired by a biliary surgeon after a delay of 4–6 weeks once the external biliary fistula has closed.

Keywords

bile duct injury / cholecystectomy / laparoscopic cholecystectomy

References

[1] Thomson BN, Parks RW, Madhavan KK, Wigmore SJ, Garden OJ. Early specialist repair of biliary injury. Br J Surg 2006; 93(2): 216–220

[2] Holte K, Bardram L, Wettergren A, Rasmussen A. Reconstruction of major bile duct injuries after laparoscopic cholecystectomy. Dan Med Bull 2010; 57(2): A4135

[3] Perera MT, Silva MA, Hegab B, Muralidharan V, Bramhall SR, Mayer AD, Buckels JA, Mirza DF. Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injuries is associated with an improved long-term outcome. Ann Surg 2011; 253(3): 553–560

[4] Iannelli A, Paineau J, Hamy A, Schneck AS, Schaaf C, Gugenheim J. Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie. HPB (Oxford) 2013; 15(8): 611–616

[5] Törnqvist B, Strömberg C, Persson G, Nilsson M. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 2012; 345: e6457

[6] de Reuver PR, Busch OR, Rauws EA, Lameris JS, van Gulik TM, Gouma DJ. Long-term results of a primary end-to-end anastomosis in peroperative detected bile duct injury. J Gastrointest Surg 2007; 11(3): 296–302

[7] Sahajpal AK, Chow SC, Dixon E, Greig PD, Gallinger S, Wei AC. Bile duct injuries associated with laparoscopic cholecystectomy: timing of repair and long-term outcomes. Arch Surg 2010; 145(8): 757–763

[8] Kapoor VK. Bile duct injury repair: when? what? who? J Hepatobiliary Pancreat Surg 2007; 14(5): 476–479

[9] Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford); 13(1): 1–14

[10] Felekouras E, Petrou A, Neofytou K, Moris D, Dimitrokallis N, Bramis K, Griniatsos J, Pikoulis E, Diamantis T. Early or delayed intervention for bile duct injuries following laparoscopic cholecystectomy? A dilemma looking for an answer. Gastroenterol Res Pract 2015; 2015: 104235

[11] Stilling NM, Fristrup C, Wettergren A, Ugianskis A, Nygaard J, Holte K, Bardram L, Sall M, Mortensen MB. Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study. HPB (Oxford)2015; 17(5):394–400 

[12] Nuzzo G, Giuliante F, Giovannini I. Timing of repair of bile duct injuries associated with laparoscopic cholecystectomy. Arch Surg 2011; 146(1): 117, author reply 117–118

[13] Stewart L, Way LW. Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB (Oxford) 2009; 11(6): 516–522

[14] Xu XD, Zhang YC, Gao P, Bahrani-Mougeot F, Zhang LY, He ZY, Zhang YW, Ma JZ. Treatment of major laparoscopic bile duct injury: a long-term follow-up result. Am Surg 2011; 77(12): 1584–1588

[15] Perera MT, Silva MA, Shah AJ, Hardstaff R, Bramhall SR, Issac J, Buckels JA, Mirza DF. Risk factors for litigation following major transectional bile duct injury sustained at laparoscopic cholecystectomy. World J Surg 2010; 34(11): 2635–2641

[16] Gossage JA, Forshaw MJ. Prevalence and outcome of litigation claims in England after laparoscopic cholecystectomy. Int J Clin Pract 2010; 64(13): 1832–1835

[17] Dageforde LA, Landman MP, Feurer ID, Poulose B, Pinson CW, Moore DE. A cost-effectiveness analysis of early vs. late reconstruction of iatrogenic bile duct injuries. J Am Coll Surg 2012; 214(6): 919–927

[18] Sikora SS, Pottakkat B, Srikanth G, Kumar A, Saxena R, Kapoor VK. Postcholecystectomy benign biliary strictures — long-term results. Dig Surg 2006; 23(5−6): 304–312

[19] Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campbell KA, Talamini MA, Sauter PA, Coleman J, Yeo CJ. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg 2000; 232(3): 430–441

[20] Silva MA, Coldham C, Mayer AD, Bramhall SR, Buckels JA, Mirza DF. Specialist outreach service for on-table repair of iatrogenic bile duct injuries—a new kind of ‘travelling surgeon’. Ann R Coll Surg Engl 2008; 90(3): 243–246

[21] Krige JE, Bornman PC, Kahn D. Bile leaks and sepsis: drain now, fix later. Arch Surg 2010; 145(8): 763

RIGHTS & PERMISSIONS

2014 Higher Education Press and Springer-Verlag Berlin Heidelberg