Long-term follow-up and risk factors for strictures after hepaticojejunostomy for bile duct injury: An analysis of surgical and percutaneous treatment in a tertiary center
| Autor: | Thomas M. van Gulik, Dirk J. Gouma, Erik A.J. Rauws, Robert J.S. Coelen, Otto M. van Delden, Olivier R. Busch, Marc G. Besselink, Philip R. de Reuver, Klaske A. C. Booij |
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| Přispěvatelé: | Graduate School, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Surgery, ACS - Amsterdam Cardiovascular Sciences, Radiology and Nuclear Medicine, Other departments |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Percutaneous business.industry Bile duct Long term follow up medicine.medical_treatment 030230 surgery Anastomosis Constriction Surgery 03 medical and health sciences Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] 0302 clinical medicine medicine.anatomical_structure All institutes and research themes of the Radboud University Medical Center Interquartile range 030220 oncology & carcinogenesis Medicine Cholecystectomy Bile Duct Diseases business |
| Zdroj: | Surgery, 163, 5, pp. 1121-1127 Surgery, 163, 1121-1127 Surgery, 163(5), 1121-1127. Mosby Inc. |
| ISSN: | 0039-6060 |
| Popis: | Background Hepaticojejunostomy is commonly indicated for major bile duct injury after cholecystectomy. The debate about the timing of hepaticojejunostomy for bile duct injury persists since data on postoperative outcomes, including postoperative strictures, are lacking. The aim of this study was to analyze short- and long-term outcomes of hepaticojejunostomy for bile duct injury, including risk factors for strictures. Method Analysis of outcome of hepaticojejunostomy in bile duct injury patients referred to a multidisciplinary team. Results Between the years1991 and 2016, 281 patients underwent hepaticojejunostomy for bile duct injury. Clavien-Dindo grade III complications occurred in 31 patients (11%) and 90-day mortality occurred in 2 patients (0.7%). After a median follow-up of 10.5 years (interquartile range 6.7–14.8 years), clinically relevant strictures were found in 37 patients (13.2%). Strictures were treated with percutaneous dilatation in 33 patients (89.2%), and 4 patients (1.4%) were reoperated. The stricture rate in patients undergoing hepaticojejunostomy 90 days after bile duct injury was 15.8%, 18.7%, and 9.9%, respectively. The stricture rate for early versus intermediate and late repair did not differ (P = 0.766 and 0.431, respectively). The stricture rate for repair after 14–90 days, however, was higher compared with repair >90 days after bile duct injury (P = 0.045). In multivariable analysis male gender was the only independent variable associated with stricture formation (OR 6.7, 95% CI 1.8–25.4, P = 0.005). Conclusion Hepaticojejunostomy is a relatively safe treatment of bile duct injury. Timing of surgery and intermediate repair affect long-term stricture rate; most anastomotic strictures can be treated successfully with percutaneous dilation. |
| Databáze: | OpenAIRE |
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