Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 22; pp. 6924 - 6931
• Main Authors: Eum, Young Ook, Park, Joo Kyung, Chun, Jaeyoung, Lee, Sang-Hyub, Ryu, Ji Kon, Kim, Yong-Tae, Yoon, Yong-Bum, Yoon, Chang Jin, Han, Ho-Seong, Hwang, Jin-Hyeok
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.06.2014
• Subjects: Adult; Aged; Aged, 80 and over; Anastomotic Leak - diagnosis; Anastomotic Leak - etiology; Anastomotic Leak - therapy; Bile Ducts - injuries; Bile Ducts - surgery; Biliary Tract Surgical Procedures - adverse effects; Catheters; cholangiography; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholangiopancreatography, Magnetic Resonance; Cholestasis - diagnosis; Cholestasis - etiology; Cholestasis - therapy; Constriction, Pathologic; Dilatation; Drainage - adverse effects; Drainage - instrumentation; Endoscopic; Equipment Design; Evidence-Based Medicine; Female; Hospitals, University; Humans; Male; Middle Aged; Percutaneous; Republic of Korea; retrograde; Sphincterotomy, Endoscopic - adverse effects; Stents; Tertiary Care Centers; Tomography, X-Ray Computed; Treatment Outcome; Young Adult; Republic of Korea; Biliary stricture; Percutaneous transhepatic cholangiography; Endoscopic retrograde cholangiography; Bile duct; Percutaneous transhepatic biliary drainage
• DOI: 10.3748/wjg.v20.i22.6924
• ISSN: 1007-9327

AIM:To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries(BDIs).METHODS:The study patients were enrolled from the pancreatobiliary units of a tertiary teaching hospital for the treatment of BDIs after hepatobiliary tract surgeries,excluding operations for liver transplantation andmalignancies,from January 1999 to August 2010.A total of 5167 patients underwent operations,and 77patients had BDIs following surgery.The primary end point was the treatment success rate according to different types of BDIs sustained using endoscopic or percutaneous hepatic approaches.The type of BDI was defined using one of the following diagnostic tools:endoscopic retrograde cholangiography,percutaneous transhepatic cholangiography,computed tomography scan,and magnetic resonance cholangiography.Patients with a final diagnosis of BDI underwent endoscopic and/or percutaneous interventions for the treatment of bile leak and/or stricture if clinically indicated.Patient consent was obtained,and study approval was granted by the Institutional Review Board in accordance with the legal regulations of the Human Clinical Research Center at the Seoul National University Hospital in Seoul,South Korea.RESULTS:A total of 77 patients were enrolled in the study.They were divided into three groups according to type of BDI.Among them,55 patients(71%)underwent cholecystectomy.Thirty-six patients(47%)had bile leak only(type 1),31 patients had biliary stricture only(type 2),and 10 patients had both bile leak and biliary stricture(type 3).Their initial treatment modalities were non-surgical.The success rate of non-surgical treatment in each group was as follows:BDI type 1:94%;type 2:71%;and type 3:30%.Clinical parameters such as demographic factors,primary disease,operation method,type of operation,non-surgical treatment modalities,endoscopic procedure steps,type of BDI,time to diagnosis and treatment duration were evaluated to evaluate the prognostic factors affecting the success rate.The type of BDI was a statistically significant prognostic factor in determining the success rate of non-surgical treatment.In addition,a shorter time to diagnosis of BDI after the operation correlated significantly with higher success rates in the treatment of type 1 BDIs.CONCLUSION:Endoscopic or percutaneous hepatic approaches can be used as an initial treatment in type1 and 2 BDIs.However,surgical intervention is a treatment of choice in type 3 BDI.