RT Journal
A1 Murr MM, Gigot J, Nagorney DM, Harmsen WS, Ilstrup DM, Farnell MB
T1 LOng-term results of biliary reconstruction after laparoscopic bile duct injuries
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD June 1
VO 134
IS 6
SP 604
OP 610
DO 10.1001/archsurg.134.6.604
UL http://dx.doi.org/10.1001/archsurg.134.6.604
AB Hypothesis 
    The Hepp-Couinaud approach to biliary enteric reconstruction for laparoscopic bile duct injuries provides a durable, long-term result in most patients.Design 
    Retrospective study of patients who underwent operative repair of laparoscopic bile duct injuries from January 1990 through December 1997.Setting 
    Academic tertiary referral center.Main Outcome Measures 
    Outcome was assessed using a grading system based on clinical symptoms, liver function tests, and need for reintervention for anastomotic stricture. The Kaplan-Meier method was employed to estimate stricture-free survival.Results 
    Fifty-nine consecutive patients underwent operative repair of the following laparoscopic bile duct injuries (Strasberg classification): B: n=2 (3%), C: n=1 (1%), D: n=2 (3%), E1: n=5 (8%), E2: n=16 (27%), E3: n=25 (42%), E4: n=5 (8%), and E5: n=3 (5%). Forty-seven patients (80%) had 1 or more interventions prior to the index repair. The extrahepatic left bile duct (Hepp-Couinaud approach) was used in 46 of 53 patients who underwent a Roux-en-Y hepaticojejunostomy. Follow-up (mean ± SEM, 3.7 ± 0.3 years) was complete in 54 of the 57 patients still alive. Five patients developed subsequent anastomotic strictures and were treated with percutaneous transhepatic dilation (n=3), endoscopic dilation (n=1), and operative revision (n=1). Excellent to good long-term results were achieved in the remaining 49 patients (91%). Life-table analysis yielded 95% and 88% chances of stricture-free survival at 2 and 5 years, respectively.Conclusions 
    Complex iatrogenic proximal bile duct injuries and strictures are amenable to operative repair using the extrahepatic left bile duct. The Hepp-Couinaud approach offers a durable result in more than 90% of patients, even after previous interventions have failed.