Document Detail

Hepatic resection for post-cholecystectomy bile duct injuries: a literature review.
MedLine Citation:
PMID:  20590909     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study seeks to identify factors for hepatectomy in the management of post-cholecystectomy bile duct injury (BDI) and outcome via a systematic review of the literature.
METHODS: Relevant literature was found by searching the PubMed database and the bibliographies of extracted articles. To avoid bias selection, factors for hepatectomy were analysed in series reporting both patients undergoing hepatectomy and patients undergoing biliary repair without hepatectomy (bimodal treatment). Relevant variables were the presence or absence of additional hepatic artery and/or portal vein injury, the level of BDI, and a previous biliary repair.
RESULTS: Among 460 potentially relevant publications, only 31 met the eligibility criteria. A total of 99 hepatectomies were reported among 1756 (5.6%) patients referred for post-cholecystectomy BDI. In eight series reporting bimodal treatment, including 232 patients, logistic regression multivariate analysis showed that hepatic arterial and Strasberg E4 and E5 injuries were independent factors associated with hepatectomy. Patients with combined arterial and Strasberg E4 or E5 injury were 43.3 times more likely to undergo hepatectomy (95% confidence interval 8.0-234.2) than patients without complex injury. Despite high postoperative morbidity, mortality rates were comparable with those of hepaticojejunostomy, except in urgent hepatectomies (within 2 weeks; four of nine patients died). Longterm outcome was satisfactory in 12 of 18 patients in the largest series.
CONCLUSIONS: Hepatectomies were performed mainly in patients showing complex concurrent Strasberg E4 or E5 and hepatic arterial injury and provided satisfactory longterm outcomes despite high postoperative morbidity.
Stéphanie Truant; Emmanuel Boleslawski; Gilles Lebuffe; Géraldine Sergent; François-René Pruvot
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  HPB : the official journal of the International Hepato Pancreato Biliary Association     Volume:  12     ISSN:  1477-2574     ISO Abbreviation:  HPB (Oxford)     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-01     Completed Date:  2011-02-09     Revised Date:  2011-07-28    
Medline Journal Info:
Nlm Unique ID:  100900921     Medline TA:  HPB (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  334-41     Citation Subset:  IM    
Department of Digestive Surgery and Transplantation, University Hospitals, Lille, France.
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MeSH Terms
Bile Ducts / injuries*,  surgery*
Chi-Square Distribution
Cholecystectomy, Laparoscopic / adverse effects*
Hepatectomy* / adverse effects,  mortality
Hepatic Artery / injuries,  surgery
Iatrogenic Disease
Logistic Models
Patient Selection
Portal Vein / injuries,  surgery
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Wounds and Injuries / etiology,  mortality,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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