Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries

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• 作者：Amine Benkabbou ; MD^a ; Denis Castaing ; MD^a ; ^b ; ^c ; Chady Salloum ; MD^a ; René ; Adam ; MD ; PhD^a ; ^c ; ^d ; Daniel Azoulay ; MD ; PhD^a ; ^c ; Eric Vibert ; MD ; PhD^a ; ^b ; ^c ; ^{eric.vibert@pbr.aphp.fr}
• 刊名：Surgery
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：153
• 期：1
• 页码：95-102
• 全文大小：387 K

文摘

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Background

Roux-en-Y hepaticojejunostomy (RYHJ) is the most well-accepted treatment for most post-cholecystectomy bile duct injuries (BDI). RYHJ failure is a complex situation that requires expert planning and the possibility of using a combination of operative, radiologic, and endoscopic techniques. The aim of this study was to report our experience with a multidisciplinary approach to failed RYHJ after post-cholecystectomy BDI.

Methods

Between January 1996 and March 2008, 44 consecutive patients were managed for RYHJ failure in our department. They presented with recurrent cholangitis in 40 patients (91 % ) and/or jaundice in 9 (20 % ). First-line treatment consisted of primary revisionary surgery in 26 cases (59 % ; repeat RYHJ in 22 and hepatectomy in 4) and a percutaneous approach in 18 cases (41 % ; biliary interventions in 16 and portal vein embolization in 2).

Results

Postoperative mortality was nil. Postoperative morbidity was 11 % after repeat RYHJ without hepatectomy, 80 % (bile leaks) after hepatectomy, and 10 % (mild cholangitis and hemobilia) after a percutaneous approach. Delayed revisionary surgery with the intent to wait for bile duct dilation failed in all 5 patients. With a mean follow-up of 49 ¡À 40 months, second- or third-line treatment was attempted in 7 patients (16 % ). One patient (2 % ) died because of suicide. Overall clinical success defined by the absence of incapacitating biliary symptoms after treatment was achieved in 39 patients (89 % ).

Conclusion

An immediate, multidisciplinary approach including repeat biliary surgery and/or a percutaneous approach in a tertiary hepatobiliary center is required to obtain good, long-term results when treating the failure of RYHJ post-cholecystectomy BDI.