Editorial
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Apr 27, 2011; 3(4): 43-48
Published online Apr 27, 2011. doi: 10.4240/wjgs.v3.i4.43
Classification and management of bile duct injuries
Miguel Angel Mercado, Ismael Domínguez
Miguel Angel Mercado, Ismael Domínguez, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, P.C.14000 México, DF, Mexico
Author contributions: Mercado MA and Domínguez I were both responsible for the design, conception, drafting and final approval of this paper.
Correspondence to: Miguel Angel Mercado, MD, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Vasco de Quiroga 15 Colonia Sección XVI Tlalpan, P.C.14000 México, DF, Mexico. miguel.mercadod@quetzal.innsz.mx
Telephone: +52-55-739321 Fax: +52-55-739321
Received: February 23, 2011
Revised: March 25, 2011
Accepted: April 1, 2011
Published online: April 27, 2011
Abstract

To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GI-1990-99 (33 cases), GII- 2000-2004 (139 cases) and GIII- 2004-2008 (140 cases). All patients were treated with a Roux en Y hepatojejunostomy. A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001). Partial segment IV and V resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis). Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period. The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair. Even interested and tertiary care centers have a learning curve.

Keywords: Bile duct injury, Hepatojejunoanastomosis, Biliary repair, Hepatectomy, Cholangitis