Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal, 700020, India.
Updates Surg. 2022 Oct;74(5):1543-1550. doi: 10.1007/s13304-022-01325-2. Epub 2022 Jul 16.
The aim of the study is to report the outcomes of reoperative surgery for late failure of postcholecystectomy bile duct injury (BDI) repair. All the patients, who underwent a reoperative surgery for late failure of postcholecystectomy BDI repair at our institution between August 2007 and July 2020, were retrospectively reviewed. Of the total 262 patients of BDI repair, 66 underwent reoperative surgery for late failure. Median duration between last attempt repair and the onset of recurrent symptoms was 18 months. Eighty-five percent of patients with failed repair became symptomatic within 5 years of attempt repair. The most common type of BDI was E3. All the patients underwent Roux-en-Y hepaticojejunostomy. Twenty-nine postoperative complications developed in 23 (35%) patients. Postoperative mortality was 1.5%. Median postoperative hospital stay was 9 (5-61) days. Over a median follow-up of 80 (12-150) months, 5.2% (3/58) of patients developed clinically relevant anastomotic stricture. Three patients with secondary biliary cirrhosis died in the follow-up period due to decompensated liver disease. Overall, excellent or good long-term outcome was achieved in 83% (48/58) of patients which was significantly less satisfactory than primary repair patients (82.8% vs 92.7%, p = 0.039). Reoperative surgery is safe in patients with failed repair after postcholecystectomy BDI and good long-term clinical success can be achieved in most of the patients. The long-term results were less satisfactory in failed-repair group than those who underwent primary repair at our institution. Early referral to a specialized unit for BDI repair may improve long-term outcome.
本研究旨在报告胆囊切除术后胆管损伤（BDI）修复后晚期失败再手术的结果。回顾性分析 2007 年 8 月至 2020 年 7 月在我院行再手术治疗胆囊切除术后 BDI 修复后晚期失败的所有患者。在接受 BDI 修复的 262 例患者中，有 66 例因晚期失败而行再手术。末次尝试修复与复发性症状出现之间的中位时间为 18 个月。85%的修复失败患者在尝试修复后 5 年内出现症状。失败修复最常见的 BDI 类型为 E3。所有患者均行 Roux-en-Y 肝肠吻合术。23 例（35%）患者发生 29 例术后并发症。术后死亡率为 1.5%。术后中位住院时间为 9 天（5-61 天）。在中位随访 80 个月（12-150 个月）期间，5.2%（3/58）的患者发生临床相关吻合口狭窄。3 例继发性胆汁性肝硬化患者在随访期间因肝功能失代偿而死亡。总体而言，83%（48/58）的患者获得了良好或优秀的长期预后，明显低于初次修复患者（82.8%比 92.7%，p=0.039）。对于胆囊切除术后 BDI 修复后失败的患者，再手术是安全的，大多数患者可获得良好的长期临床效果。但在失败修复组，长期结果不如我院初次修复组满意。早期转至专门的 BDI 修复单位可能会改善长期预后。
