Hepaticojejunostomy vs end-to-end biliary reconstructions in treatment of bile duct injury

One discussion this week included treatments for bile duct injury.

Reference: Jablonska B, et al. Hepaticojejunostomy vs end-to-end biliary reconstructions in the treatment of iatrogenic bile duct injuries. Journal of Gastrointestinal Surgery. 2009 Jun;13(6):1084-1093. doi:10.1007/s11605-009-0841-7.

Summary: Iatrogenic bile duct injuries (IBDI) most frequently develop during cholecystectomy. An increase in patients with IBDI has been associated with the widespread use of laparoscopic cholecystectomy (p.1084).

Jablonska et al (2009) clarify that the Roux-Y hepaticojejunostomy (HJ) is the most frequently recommended type of reconstruction. End-to-end ductal anastomosis (EE) is used very seldom in the surgical treatment of IBDI but is performed during hepatic transplantation with good results.

In this study by Jablonska et al (2009), 94 patients underwent reconstructive surgery for IBDI (49, Roux-Y HJ, and 45, EE) between January 1990 and March 2005. The major findings include:

  • Early complications occurred more after HJ (24.5%) than after EE (6.7%).
  • Wound infection was most frequent early complication: 16.3% of HJ group, 2.2% of EE group.
  • HJ group saw 2% early postoperative mortality rate, and 8% early reoperations rate. EE group saw no mortality, no early reoperations.
  • Excellent/good long-term results were observed in 78.94% of HJ group, and 77.42% of EE group.
  • Recurrent stricture was observed in 2 HJ patients (5.3%) and 3 EE patients (9.6%).
  • Quality of life in both groups was comparable.

“This study emphasizes that it is possible to achieve very good long-term results and high quality of life using both HJ and the EE” (p.1092).

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