Long-term results of large diameter hepaticojejunostomy for treatment of Bile Duct Injuries following cholecystectomy.

Akaraviputh, T; Boonnuch, W; Lohsiriwat, V; Methasate, A; Chinswangwatanakul, V; Lert-akayamanee, N; Lohsiriwat, D

Long-term results of large diameter hepaticojejunostomy for treatment of Bile Duct Injuries following cholecystectomy.

Date

2006-05-08

Authors

Chinswangwatanakul, V

Lert-akayamanee, N

Lohsiriwat, D

Abstract

OBJECTIVE: Bile Duct Injury (BDI) is one of the most serious complications of cholecystectomy. The authors analyzed the clinical presentation, surgical management and long-term outcome of 19 patients presenting with iatrogenic major BDIs (Straburg type E) following cholecystectomy who underwent Roux-en-Y hepaticojejunostomy. MATERIAL AND METHOD: Between 1992 and 2005, 19 patients with major BDIs (Strasberg type E) following cholecystectomy were included. Operative notes and charts of all patients were reviewed systematically. A follow-up examination of each patient was performed after a median of 22 months (range 1-120). RESULTS: Twelve patients presented with ascending cholangitis, two patients were referred to the hospital with biliary-cutaneous fistula and five patients (26.3%) were identified at the time of operations. All patients were treated with Roux-en-Y hepaticojejunostomy with at least 2 cm of the diameter of the biliary-enteric anastomosis. There was no postoperative mortality. Postoperative complication was found in 5 patients (26.3%). Until now, during the follow-up, neither clinical nor biochemical evidence of recurrent cholangitis has been found. CONCLUSION: Major BDIs are associated with high morbidity rate and prolonged hospitalization. Early detection and referral to an experienced center is crucial in the management of these patients. Roux-en-Y hepaticojejunostomy with large diameter of the biliary-enteric anastomosis is the surgical procedure of choice with good long-term outcome.

Description

Chotmaihet Thangphaet.

Citation

Akaraviputh T, Boonnuch W, Lohsiriwat V, Methasate A, Chinswangwatanakul V, Lert-akayamanee N, Lohsiriwat D. Long-term results of large diameter hepaticojejunostomy for treatment of Bile Duct Injuries following cholecystectomy. Journal of the Medical Association of Thailand. 2006 May; 89(5): 657-62