Long-term follow-up of 120 patients after hepaticojejunostomy for treatment of post-cholecystectomy bile duct injuries: A retrospective cohort study. (June 2015)

• Record Type: Journal Article
• Authors: AbdelRafee, Ahmed; El-Shobari, Mohamed; Askar, Waleed; Sultan, Ahmad M.; El Nakeeb, Ayman
• Is Part Of: International journal of surgery. Volume 18(2015)
• Page Start: 205
• Page End: 210
• Publication Date: 2015-06
• Subjects: Bile duct injury -- Hepaticojejunostomy -- Anastomotic stricture; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2015.05.004
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Long-term follow-up is essential for assessment of success of the surgical repair of post-cholecystectomy bile duct injuries (BDI). Factors affecting the long-term outcome and satisfactory length of follow-up have been little reported in the literature. The aim of this study is long-term evaluation of hepaticojejunostomy regarding clinical, radiological, laboratory and quality of life assessment. Method: Between January 1992 to December 2007, 120 patients with postcholecystectomy bile duct injury surgically treated by hepaticojejunostomy Roux-en-Y were followed up for 20 years in Mansoura Gastro-enterology Center. Long-term outcomes and quality of life (QOL) were evaluated for all patients. Univariate and multivariate analyses were done for detection of factors affecting long-term outcome. Results: The median follow up period was 149 months, range (70–246 months). Successful long-term outcome was detected in 106 (88.3%) patients. Long-term complications were detected in 35 (29%) patients. Fourteen (11.6%) patients developed anastomotic stricture within different follow up intervals up to 17 years, of which. Seventeen (14.2%) patients developed recurrent episodes of cholangitis at median interval 48 months, range (2–156 months). Post-ERCP pancreatitis, number of anastomosis, operative time, post-operative early complications, and post-operative bile leak were predictors for poor outcome. Physical component was much more affected than mental component in QOL. Conclusion: Management of BDI in specialized centers is highly recommended. Longer time for follow-up of the patients of surgical repair of bile duct injury up to 20 years should be adopted to ensure successful outcome. Quality of life assessment is essential component of long-term follow-up. Highlights: Fourteen (11.6%) patients had anastomotic stricture manifested at median interval 63 months, range (2–204 months). Seventeen (14.2%) patients developed recurrent episodes of cholangitis at median interval 48 months. As regard quality of life assessment, the physical component was more affected than the mental component. Post-ERCP pancreatitis, number of anastomosis, operative time, post-operative early complications, and post-operative bile leak were independent risk factors for poor outcome.