Impact of referral pattern and timing of repair on surgical outcome after reconstruction of post-cholecystectomy bile duct injury: A multicenter study
| Autor: | Mohamed Abd ElWahab, Taha Kayed, Helmy Ezzat, Mohamed F. Attia, Ayman El Nakeeb, Ahmad M. Sultan, Mohammed M. Mohammed, Ayman Hassanen, Ahmad AlMalki, Ahmed Alqarni |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Multivariate analysis Cirrhosis medicine.medical_treatment education Jejunostomy Hepatic Duct Common Bile Duct Diseases 030230 surgery Anastomosis behavioral disciplines and activities Time-to-Treatment 03 medical and health sciences Postoperative Complications 0302 clinical medicine medicine Humans Retrospective Studies Hepatology Bile duct business.industry Gastroenterology Stent Guideline Middle Aged Plastic Surgery Procedures medicine.disease Surgery medicine.anatomical_structure Cholecystectomy Laparoscopic Female 030211 gastroenterology & hepatology Cholecystectomy Bile Ducts Ligation business Follow-Up Studies |
| Zdroj: | Hepatobiliary & Pancreatic Diseases International. 20:53-60 |
| ISSN: | 1499-3872 |
| DOI: | 10.1016/j.hbpd.2020.10.001 |
| Popis: | Background Bile duct injury (BDI) after cholecystectomy remains a significant surgical challenge. No guideline exists to guide the timing of repair, while few studies compare early versus late repair BDI. This study aimed to analyze the outcomes in patients undergoing immediate, intermediate, and delayed repair of BDI. Methods We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020. The patients were divided into three groups based on the time of BDI reconstruction. Group 1 underwent an immediate reconstruction (within the first 72 hours post-cholecystectomy, n = 156); group 2 underwent an intermediate reconstruction (from 4 days to 6 weeks post-cholecystectomy, n = 75), and group 3 underwent delayed reconstruction (after 6 weeks post-cholecystectomy, n = 181). Results Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3. Favorable outcome was observed in 111 (71.2%) patients in group 1, 31 (41.3%) patients in group 2, and 157 (86.7%) patients in group 3 (P = 0.0001). Multivariate analysis identified that complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1, the use of external stent was an independent factor of favorable outcome in group 2, and level E4 BDI was an independent factor of unfavorable outcome in group 3. Transected BDI and level E4 BDI were independent factors of unfavorable outcome. Conclusions Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI. Complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of a favorable outcome. |
| Databáze: | OpenAIRE |
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