Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study

• Published in: HPB
• Main Authors: Rystedt J.M.L., Kleeff J., Salvia R., Besselink M.G., Prasad R., Lesurtel M., Sturesson C., Abu Hilal M., Aljaiuossi A., Antonucci A., Ardito F., Ausania F., Bernon M., Berrevoet F., Björnsson B., Bonsing B.A., Boonstra E.A., Bracke B., Brusadin R., Burda L., Caraballo M., Casellas-Robert M., Çoker A., Davide J., De Gelder A., De Rose A.M., Djokic M., Dudek K., Ekmekçigil E., Filauro M., Fülöp A., Gallagher T., Gastaca M., Gefen R., Giuliante F., Habibeh H., Halle-Smith J., Haraldsdottir K.H., Hartman V., Hauer A., Hemmingsson O., Hoskovec D., Isaksson B., Jonas E., Khalaileh A., Klug R., Krige J., Lignier D., Lindemann J., López-López V., Lucidi V., Mabrut J.-Y., Månsson C., Mieog S., Mirza D.F., Oldhafer K.J., Omoshoro-Jones J.A.O., Ortega-Torrecilla N., Otto W., Panaro F., Pando E., Paterna-López S., Pekmezci S., Pesce A., Porte R.J., Poves I., Prieto Calvo M., Primavesi F., Puleo S., Recordare A., Rizell M., Roberts K., Robles-Campos R., Sanchiz-Cardenas E., Sandström P., Saribeyoglu K., Schauer M., Schreuder M., Siriwardena A.K., Smith M.D., Sousa Silva D., Sparrelid E., Stättner S., Stavrou G.A., Straka M., Strömberg C., Sutcliffe R.P., Szijártó A., Taflin H., Trotovšek B., van Gulik T., Wallach N., Zieniewicz K., A European-African HepatoPancreatoBiliary Association (E-AHPBA)Research Collaborative Study management group, Other members of the European-African HepatoPancreatoBiliary Association Research Collaborative
• Other Authors: Ege Üniversitesi
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier B.V. 2019
• Subjects: Ege; Genova; Hani; Ortega; Prieto; Robles; Sutcliffe; Iceland
• Online Access: https://hdl.handle.net/11454/15843; https://doi.org/10.1016/j.hpb.2019.04.003

Background: Treatment of bile duct injuries (BDI)during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy. Methods: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0–7), intermediate (1–6 weeks)and late (6 weeks–6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality. Results: In total 913 patients from 48 centers were included in the analysis. In 401 patients (44%)the bile duct injury was diagnosed intraoperatively, and 126 patients (14%)suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37–8.65; p = 0.009). Conclusion: After BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable. © 2019 International Hepato-Pancreato-Biliary Association Inc. Rijksuniversiteit Groningen Università degli Studi di Verona Universitair Medisch Centrum Utrecht Warszawski Uniwersytet Medyczny Lunds Universitet Universiteit van Amsterdam Semmelweis Egyetem Universitair Medisch Centrum Groningen Leids Universitair Medisch Centrum Department of Surgery Sahlgrenska Universitetssjukhuset Abu Hilal M 8 , Aljaiuossi A 8 , Antonucci A 9 , Ardito F 10 , Ausania F 11 , Bernon M 12 , Berrevoet F 13 , Björnsson B 14 , Bonsing BA 15 , Boonstra EA 16 , Bracke B 17 , Brusadin R 18 , Burda L 19 , Caraballo M 20 , Casellas-Robert M 21 , Çoker A 22 , Davide J 23 , De Gelder A 13 , De Rose AM 10 , Djokic M 24 , Dudek K 25 , Ekmekçigil E 22 , Filauro M 26 , Fülöp A 27 , Gallagher TK 28 , Gastaca M 29 , Gefen R 30 , Giuliante F 10 , Habibeh H 31 , Halle-Smith J 32 , Haraldsdóttir KH 33 , Hartman V 17 , Hauer A 34 , Hemmingsson O 35 , Hoskovec D 36 , Isaksson B 37 , Jonas E 12 , Khalaileh A 30 , Klug R 34 , Krige J 12 , Lignier D 38 , Lindemann J 12 , López-López V 18 , Lucidi V 39 , Mabrut J-Y 6 , Månsson C 37 , Mieog S 15 , Mirza DF 32 , Oldhafer KJ 40 , Omoshoro-Jones JAO 41 , Ortega-Torrecilla N 42 , Otto W 25 , Panaro F 31 , Pando E 42 , Paterna-López S 43 , Pekmezci S 44 , Pesce A 45 , Porte RJ 16 , Poves I 46 , Prieto Calvo M 29 , Primavesi F 47 , Puleo S 45 , Recordare A 48 , Rizell M 49 , Roberts K 32 , Robles-Campos R 18 , Sanchiz-Cardenas E 50 , Sandström P 14 , Saribeyoglu K 44 , Schauer M 51 , Schreuder M 4 , Siriwardena AK 52 , Smith MD 41 , Sousa Silva D 23 , Sparrelid E 7 , Stättner S 47 , Stavrou GA 40 , Straka M 19 , Strömberg C 7 , Sutcliffe RP 32 , Szijártó A 27 , Taflin H 49 , Trotovšek B 24 , van Gulik T 4 , Wallach N 6 , Zieniewicz K 25 1 Skåne University Hospital, Lund University, Lund, Sweden 2 University Hospital Halle Saale, Germany 3 University of Verona, Verona, Italy 4 Amsterdam UMC, University of Amsterdam, the Netherlands 5 St James University Hospital, Leeds, United Kingdom 6 Department of Digestive Surgery and Liver Transplantation, Croix Rousse University Hospital, University of Lyon I, Lyon, France 7 Karolinska University Hospital, Stockholm, Sweden 8 University Hospital Southampton, Southampton, United Kingdom 9 Policlinico di Monza, Monza, Italy 10 Catholic University, Rome, Italy 11 Complejo Hospitalario Universitario de Vigo, Vigo, Spain 12 Groote Schuur Hospital, Cape Town, South Africa 13 Ghent University Hospital and Medical School, Gent, Belgium 14 Department of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden 15 Leiden University Medical Center, Leiden, the Netherlands 16 University of Groningen, University Medical Center Groningen, Groningen, the Netherlands 17 University Hospital of Antwerp, Antwerp, Belgium 18 Virgen de la Arrixaca University Hospita, Murcia, Spain 19 Comprehensive Cancer Centre (Agel), Novy Jicin, Czech Republic 20 Hospital Universitario de Salamanca, Salamanca, Spain 21 Hospital Universitari Dr Josep Trueta, Girona, Spain 22 Ege University School of Medicine Hospital, Izmir, Turkey 23 Centro Hospitalar do Porto, Porto, Portugal 24 University Medical Center Ljubljana, Ljubljana, Slovenia 25 Medical University of Warsaw, Warsaw, Poland 26 Galliera Hospital, Genova, Italy 27 Semmelweis University, Budapest, Hungary 28 St. Vincent's University Hospital, Dublin, Ireland 29 Cruces University Hospital, Bilbao, Spain 30 Hadassah Hospital, Jerusalem, Israel 31 Montpellier University Hospital, Montpellier, France 32 Queen Elizabeth Hospital, Birmingham, United Kingdom 33 Landspitali Univeristy Hospital, Reykjavik, Iceland 34 Community Hospital Horn, Horn, Austria 35 Department of Surgical and Perioperative Sciences, Umeå University, Sweden 36 General University Hospital Prague, Prague, Czech Republic 37 Akademiska sjukhuset, Uppsala, Sweden 38 Centre Hospitalier Universitaire d’Amiens Picardie, Amiens, France 39 Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium 40 Asklepios Klinik Barmbek, Hamburg, Germany 41 Chris Hani-Baragwanath Academic Hospital, Johannesburg, South Africa 42 Hospital Universitari Vall d'Hebron, Barcelona, Spain 43 Miguel Servet University Hospital, Zaragoza, Spain 44 Cerrahpaşa Medical Faculty, Istanbul, Turkey 45 G.F.Ingrassia, Catania, Italy 46 Hospital del Mar, Barcelona, Spain 47 Medical University of Innsbruck, Innsbruck, Austria 48 Peja/Pec Hospital, Pec, Kosovo 49 Sahlgrenska University hospital, Gothenburg, Sweden 50 University Hospital Virgen de la Victoria, Malaga, Spain 51 University hospital of Duesseldorf, Duesseldorf, Germany 52 Manchester Royal Infirmary, Manchester, United Kingdom --