Background

Major bile duct injuries (BDI) following cholecystectomy require complex reconstructive surgery. The aim was to collect the liver transplantations (LT) performed in France for major BDI following cholecystectomy, to analyze the risk factors and to report the results.

Methods

National multicenter observational retrospective study. All the patients who underwent a LT in France between 1994 and 2017, for BDI following cholecystectomy, were included.

Results

30 patients were included. 25 BDI occurred in non hepato-biliary expert centers, 20 were initially treated in these centers. Median time between injury and LT was 3 years in case of an associated vascular injury (11 injuries), versus 11.7 years without vascular injury (p = 0.006). Post-transplant morbidity rate was 86.7%, mortality 23.5% at 5 years.

Conclusion

Iatrogenic BDI remains a real concern with severe cases, associated with vascular damages or leading to cirrhosis, with no solution but LT. It is associated with high morbidity and not optimal results. This enlights the necessity of early referral of all major BDI in expert centers to prevent dramatic outcome. Decision to perform transplantation should be taken before dismal infectious situations or biliary cirrhosis and access to graft should be facilitated by Organ Sharing Organizations.

中文翻译：

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肝移植治疗胆囊切除术中医源性胆管损伤：一项法国回顾性多中心研究

背景

胆囊切除术后的主要胆管损伤 (BDI) 需要复杂的重建手术。目的是收集在法国进行的胆囊切除术后主要 BDI 的肝移植 (LT)，以分析危险因素并报告结果。

方法

国家多中心观察性回顾性研究。所有在 1994 年至 2017 年期间在法国接受 LT 的胆囊切除术后 BDI 患者均被纳入研究。

结果

包括30名患者。25 例 BDI 发生在非肝胆专家中心，其中 20 例在这些中心进行了初步治疗。在相关血管损伤的情况下（11 次损伤），损伤和 LT 之间的中位时间为 3 年，而没有血管损伤的情况下为 11.7 年（p = 0.006）。移植后 5 年发病率为 86.7%，死亡率为 23.5%。

结论

医源性 BDI 仍然是严重病例的真正问题，与血管损伤或导致肝硬化有关，除了 LT 没有其他解决方案。它与高发病率和非最佳结果有关。这表明有必要尽早将所有主要的 BDI 转诊到专家中心，以防止出现严重后果。应在令人沮丧的感染情况或胆汁性肝硬化之前做出进行移植的决定，器官共享组织应促进获得移植物。