Laurence Chiche1, Maxime Guieu2, Philippe Bachellier3, Bertrand Suc4, Olivier Soubrane5, Karim Boudjema6, Francis Navarro7, René Adam8, Jean-Christophe Vaillant9, Ephrem Salame10, Bruno Heyd11, Stéphanie Truant12, Jean-Philippe Adam2, Christophe Laurent2. 1. Department of Digestive Surgery, Bordeaux University Hospital, Pessac, France. Electronic address: laurence.chiche@chu-bordeaux.fr. 2. Department of Digestive Surgery, Bordeaux University Hospital, Pessac, France. 3. Department of Digestive Surgery, University Hospital of Strasbourg, France. 4. Department of Visceral Surgery, Toulouse-Rangueil University Hospital, Toulouse, France. 5. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 6. Department of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, University Hospital Rennes 1, Rennes, 35033, France. 7. Department of Visceral Surgery, University Hospital of Montpellier, France. 8. Hepato-Biliary Center, AP-HP Paul Brousse Hospital, University of Paris-Sud, Villejuif, France. 9. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, PitieSalpetriere, Paris, France. 10. Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, University Hospital of Tours, Tours, France. 11. Department of Digestive Surgery, University Hospital of Besançon, Besançon, France. 12. Department of Digestive Surgery and Transplantation, Lille University Medical Center, Lille, France.
Abstract
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.
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.