Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Evolution of the repair of bile duct injury in a high-volume center in Latin America.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Mercado Miguel Angel, Vilatoba Mario, Domínguez-Rosado Ismael, Del Val Alejandro Ramírez, Montes-Sevilla Lenyn Daniel, Aceituno-Alarcon Sebastian, Zacarias Andrea Pérez, Chalita-Joanny Jalil Antuan, Rosado-Mendoza Carlos Antonio, Carrillo-Vidal Javier
Аннотация
BACKGROUND: Bile duct injury remains one of the most challenging complications after cholecystectomy, with long-term consequences for patients. Over the past 4 decades, surgical techniques for bile duct reconstruction have evolved significantly in our institution to optimize long-term outcomes.
METHODS: This was a retrospective cohort study of 907 patients who underwent surgical repair of benign bile duct injuries at a tertiary academic center in Mexico between 1984 and 2024. Patients with malignant strictures or those requiring liver transplantation were excluded. Surgical strategies were analyzed in 3 distinct time periods based on predominant technical approaches. The clinical outcomes, including cholangitis, anastomotic stenosis, and reintervention, were recorded. Injuries were classified using the Strasberg classification.
RESULTS: Lesions classified as Strasberg types E1 to E3 accounted for 76.2% of cases, whereas lesions classified as Strasberg types E4 and E5 accounted for 23.8% and were associated with higher rates of recurrent cholangitis and reintervention. The introduction of partial resection of liver segments IV and V improved exposure of the hilar plate and allowed for tension-free anastomoses. Laterolateral anastomosis without routine stenting became standard after 2010. The overall long-term patency rate of the biliary-enteric anastomosis was 86.9%, with 78.4% of complications occurring within the first 5 years.
CONCLUSION: The surgical management of bile duct injuries has evolved toward more refined and anatomically precise approaches. Technical innovations, such as partial hepatic resection and high anastomoses, have improved exposure and outcomes. Long-term follow-up remains essential to assess the durability of reconstruction and manage delayed complications.
METHODS: This was a retrospective cohort study of 907 patients who underwent surgical repair of benign bile duct injuries at a tertiary academic center in Mexico between 1984 and 2024. Patients with malignant strictures or those requiring liver transplantation were excluded. Surgical strategies were analyzed in 3 distinct time periods based on predominant technical approaches. The clinical outcomes, including cholangitis, anastomotic stenosis, and reintervention, were recorded. Injuries were classified using the Strasberg classification.
RESULTS: Lesions classified as Strasberg types E1 to E3 accounted for 76.2% of cases, whereas lesions classified as Strasberg types E4 and E5 accounted for 23.8% and were associated with higher rates of recurrent cholangitis and reintervention. The introduction of partial resection of liver segments IV and V improved exposure of the hilar plate and allowed for tension-free anastomoses. Laterolateral anastomosis without routine stenting became standard after 2010. The overall long-term patency rate of the biliary-enteric anastomosis was 86.9%, with 78.4% of complications occurring within the first 5 years.
CONCLUSION: The surgical management of bile duct injuries has evolved toward more refined and anatomically precise approaches. Technical innovations, such as partial hepatic resection and high anastomoses, have improved exposure and outcomes. Long-term follow-up remains essential to assess the durability of reconstruction and manage delayed complications.