Background

Small sample size and a lack of standardized reporting for patients requiring reconstruction for laparoscopic cholecystectomy bile duct injuries (LC-BDI) have limited investigation of factors contributing to loss of patency.

Methods

Using a prospective database, patient characteristics, pre-repair investigations, Strasberg-Bismuth level of injury, timing of reconstruction and postoperative complications were compared in successful index reconstruction and revision patients. Multivariate analysis was performed to determine independent predictors of loss of patency.

Results

Of 131 patients analysed, 103 had a successful index reconstruction and 28 required revision. There were no statistically significant differences in patient characteristics between the two groups. Days to referral and reconstruction were significantly different (p < 0.001, p = 0.001). Patients with incomplete biliary imaging more often required a revision (p < 0.001). The only independent predictor of loss of patency was incomplete depiction of the biliary tree prior to initial reconstruction (p = 0.035, OR 10.131, 95% CI 1.180–86.987). Primary and secondary patency were 98.1% and 96.4%, respectively with no differences in 30-day complications.

Conclusions

Incomplete depiction of LC-BDI before index reconstruction was independently associated with loss of patency requiring revision. Despite the complexity of repeat biliary reconstruction, outcomes in an HPB unit were similar to that of an index reconstruction.

中文翻译：

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导致主要腹腔镜胆囊切除术胆管损伤的胆道重建术后失去通畅的因素：一项具有长期结果的观察性研究

背景

对于需要重建腹腔镜胆囊切除术胆管损伤 (LC-BDI) 的患者，样本量小且缺乏标准化报告，因此对导致失去通畅性的因素的调查有限。

方法

使用前瞻性数据库，在成功的指数重建和翻修患者中比较了患者特征、修复前调查、Strasberg-Bismuth 损伤水平、重建时间和术后并发症。进行多变量分析以确定通畅性丧失的独立预测因素。

结果

在分析的 131 名患者中，103 名成功重建索引，28 名需要翻修。两组患者特征无统计学差异。转诊和重建的天数显着不同（p  < 0.001，p  = 0.001）。胆道成像不完整的患者更常需要进行修正（p  < 0.001）。开放性丧失的唯一独立预测因素是初始重建前对胆道树的不完整描述（p  = 0.035，OR 10.131，95% CI 1.180–86.987）。主要和次要通畅率分别为 98.1% 和 96.4%，30 天并发症没有差异。

结论

指数重建前 LC-BDI 的不完整描述与需要修正的通畅性丧失独立相关。尽管重复胆道重建很复杂，但 HPB 单元的结果与索引重建的结果相似。