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Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy - an E-AHPBA multi-center study.
HPB ( IF 2.7 ) Pub Date : 2019-12-01 , DOI: 10.1016/j.hpb.2019.04.003 Jenny M.L. Rystedt , Jörg Kleeff , Roberto Salvia , Mark G. Besselink , Raj Prasad , Mickael Lesurtel , Christian Sturesson , M. Abu Hilal , A. Aljaiuossi , A. Antonucci , F. Ardito , F. Ausania , M. Bernon , F. Berrevoet , B. Björnsson , B.A. Bonsing , E.A. Boonstra , B. Bracke , R. Brusadin , L. Burda , M. Caraballo , M. Casellas-Robert , A. Çoker , J. Davide , A. De Gelder , A.M. De Rose , M. Djokic , K. Dudek , E. Ekmekçigil , M. Filauro , A. Fülöp , T. Gallagher , M. Gastaca , R. Gefen , F. Giuliante , H. Habibeh , J. Halle-Smith , K.H. Haraldsdottir , V. Hartman , A. Hauer , O. Hemmingsson , D. Hoskovec , B. Isaksson , E. Jonas , A. Khalaileh , R. Klug , J. Krige , D. Lignier , J. Lindemann , V. López-López , V. Lucidi , J.-Y. Mabrut , C. Månsson , S. Mieog , D.F. Mirza , K.J. Oldhafer , J.A.O. Omoshoro-Jones , N. Ortega-Torrecilla , W. Otto , F. Panaro , E. Pando , S. Paterna-López , S. Pekmezci , A. Pesce , R.J. Porte , I. Poves , M. Prieto Calvo , F. Primavesi , S. Puleo , A. Recordare , M. Rizell , K. Roberts , R. Robles-Campos , E. Sanchiz-Cardenas , P. Sandström , K. Saribeyoglu , M. Schauer , M. Schreuder , A.K. Siriwardena , M.D. Smith , D. Sousa Silva , E. Sparrelid , S. Stättner , G.A. Stavrou , M. Straka , C. Strömberg , R.P. Sutcliffe , A. Szijártó , H. Taflin , B. Trotovšek , T. van Gulik , N. Wallach , K. Zieniewicz
HPB ( IF 2.7 ) Pub Date : 2019-12-01 , DOI: 10.1016/j.hpb.2019.04.003 Jenny M.L. Rystedt , Jörg Kleeff , Roberto Salvia , Mark G. Besselink , Raj Prasad , Mickael Lesurtel , Christian Sturesson , M. Abu Hilal , A. Aljaiuossi , A. Antonucci , F. Ardito , F. Ausania , M. Bernon , F. Berrevoet , B. Björnsson , B.A. Bonsing , E.A. Boonstra , B. Bracke , R. Brusadin , L. Burda , M. Caraballo , M. Casellas-Robert , A. Çoker , J. Davide , A. De Gelder , A.M. De Rose , M. Djokic , K. Dudek , E. Ekmekçigil , M. Filauro , A. Fülöp , T. Gallagher , M. Gastaca , R. Gefen , F. Giuliante , H. Habibeh , J. Halle-Smith , K.H. Haraldsdottir , V. Hartman , A. Hauer , O. Hemmingsson , D. Hoskovec , B. Isaksson , E. Jonas , A. Khalaileh , R. Klug , J. Krige , D. Lignier , J. Lindemann , V. López-López , V. Lucidi , J.-Y. Mabrut , C. Månsson , S. Mieog , D.F. Mirza , K.J. Oldhafer , J.A.O. Omoshoro-Jones , N. Ortega-Torrecilla , W. Otto , F. Panaro , E. Pando , S. Paterna-López , S. Pekmezci , A. Pesce , R.J. Porte , I. Poves , M. Prieto Calvo , F. Primavesi , S. Puleo , A. Recordare , M. Rizell , K. Roberts , R. Robles-Campos , E. Sanchiz-Cardenas , P. Sandström , K. Saribeyoglu , M. Schauer , M. Schreuder , A.K. Siriwardena , M.D. Smith , D. Sousa Silva , E. Sparrelid , S. Stättner , G.A. Stavrou , M. Straka , C. Strömberg , R.P. Sutcliffe , A. Szijártó , H. Taflin , B. Trotovšek , T. van Gulik , N. Wallach , K. Zieniewicz
BACKGROUND
Treatment of bile duct injuries (BDI) during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy.
METHODS
Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0-7), intermediate (1-6 weeks) and late (6 weeks-6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality.
RESULTS
In total 913 patients from 48 centers were included in the analysis. In 401 patients (44%) the bile duct injury was diagnosed intraoperatively, and 126 patients (14%) suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37-8.65; p = 0.009).
CONCLUSION
After BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable.
中文翻译：
胆囊切除术后胆管损伤：肝空肠吻合术的早期，中期或晚期修复-一项E-AHPBA多中心研究。
背景技术在胆囊切除术中胆管损伤（BDI）的治疗取决于损伤的严重程度和诊断时机。严重BDI的护理标准是肝空肠造口术。这项回顾性多中心研究的目的是评估肝空肠造口术修复BDI的最佳时机。方法从2000年1月至2016年6月，邀请欧洲-非洲肝胰胆道协会成员报告所有连续进行BDI的肝空肠吻合术患者。根据肝空肠吻合术胆道重建的时间对患者进行分层：早期（0-7天），中间（0-7天）。 1-6周）和晚期（6周至6个月）。主要终点是在肝空肠造口术> 90天后再次干预，次要终点是90天的严重并发症和与肝脏相关的死亡率。结果分析共纳入了来自48个中心的913例患者。在401例患者中（44％）术中被诊断出胆管损伤，而126例患者（14％）伴有血管损伤。在多变量分析中，空肠造口术的时机对术后并发症，90天后是否需要再次干预以及与肝有关的死亡率均无影响。肝空肠造口术后超过90天的再次干预率在男性患者中显着增加，而在老年患者中则降低。严重的合并症增加了肝脏相关死亡的风险（HR 3.439； CI 1.37-8.65； p = 0.009）。结论在胆囊切除术中发生BDI后，肝空肠吻合术对胆道重建的时机对严重的术后并发症没有任何影响，需要再次干预或与肝脏相关的死亡率。仍然建议进行医源性胆管损伤后的个体化治疗。
更新日期：2019-11-28
中文翻译：
胆囊切除术后胆管损伤：肝空肠吻合术的早期，中期或晚期修复-一项E-AHPBA多中心研究。
背景技术在胆囊切除术中胆管损伤（BDI）的治疗取决于损伤的严重程度和诊断时机。严重BDI的护理标准是肝空肠造口术。这项回顾性多中心研究的目的是评估肝空肠造口术修复BDI的最佳时机。方法从2000年1月至2016年6月，邀请欧洲-非洲肝胰胆道协会成员报告所有连续进行BDI的肝空肠吻合术患者。根据肝空肠吻合术胆道重建的时间对患者进行分层：早期（0-7天），中间（0-7天）。 1-6周）和晚期（6周至6个月）。主要终点是在肝空肠造口术> 90天后再次干预，次要终点是90天的严重并发症和与肝脏相关的死亡率。结果分析共纳入了来自48个中心的913例患者。在401例患者中（44％）术中被诊断出胆管损伤，而126例患者（14％）伴有血管损伤。在多变量分析中，空肠造口术的时机对术后并发症，90天后是否需要再次干预以及与肝有关的死亡率均无影响。肝空肠造口术后超过90天的再次干预率在男性患者中显着增加，而在老年患者中则降低。严重的合并症增加了肝脏相关死亡的风险（HR 3.439； CI 1.37-8.65； p = 0.009）。结论在胆囊切除术中发生BDI后，肝空肠吻合术对胆道重建的时机对严重的术后并发症没有任何影响，需要再次干预或与肝脏相关的死亡率。仍然建议进行医源性胆管损伤后的个体化治疗。
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