Document Detail

Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury.
MedLine Citation:
PMID:  12190676     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hepaticojejunostomy is the 'gold standard' procedure for repairing iatrogenic bile duct injuries. The aim of this study was to examine the long-term outcome following hepaticojejunostomy for iatrogenic bile duct injury and the utility of routine construction of an access loop. METHODS: Patients with iatrogenic biliary injuries were treated with hepaticojejunostomy and access loop by a single surgeon. Injuries were classified according to the Bismuth level. An 'excellent' outcome was achieved if the patient never experienced jaundice or cholangitis in the follow-up period, and the outcome was 'good' if the patient developed symptoms but was asymptomatic for more than 12 months. RESULTS: Forty-eight patients underwent such operation. There was one operative death. Thirty-three patients were followed for 3 years or more (mean follow-up 80.4 (range 46-118) months). Thirteen of the 33 injuries were Bismuth level II, 13 were Bismuth level III and seven were Bismuth level IV. Outcome was dependent on the Bismuth level (P < 0.001). It was excellent in all 13 patients with Bismuth level II injuries, excellent in seven and good in six of the 13 patients with Bismuth level III injuries, and excellent in one and good in six of the seven patients with Bismuth level IV injuries. Moreover, the need for access loop intervention was dependent on the Bismuth level (P < 0.001). No patient with Bismuth level II injury required intervention, compared with five of 13 with Bismuth level III and six of seven with Bismuth level IV injuries. CONCLUSION: Biliary reconstruction affords satisfactory long-term outcome. The likelihood of needing the access loop for radiological intervention is dependent on the Bismuth level. The authors recommend that an access loop be constructed in all patients with Bismuth level III and IV injuries.
R Al-Ghnaniem; I S Benjamin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of surgery     Volume:  89     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-08-22     Completed Date:  2002-09-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1118-24     Citation Subset:  AIM; IM    
Academic Department of Surgery, Guy's, King's and St Thomas' School of Medicine, King's College London, University of London, London, UK.
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MeSH Terms
Aged, 80 and over
Anastomosis, Surgical / methods
Bile Ducts / injuries*,  surgery
Biliary Tract Surgical Procedures / methods*
Cholangiography / methods
Follow-Up Studies
Iatrogenic Disease
Jejunostomy / methods*
Length of Stay
Middle Aged
Prospective Studies
Retrospective Studies
Treatment Outcome

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