Hepaticojejunostomy vs. end-to-end biliary reconstructions in the treatment of iatrogenic bile duct injuries

J Gastrointest Surg. 2009 Jun;13(6):1084-93. doi: 10.1007/s11605-009-0841-7. Epub 2009 Mar 6.

Abstract

Background: Retrospective comparison of short- and long-term results and quality of life in patients treated for iatrogenic bile duct injuries (IBDI) with Roux-Y hepaticojejunostomy (HJ) or end-to-end ductal anastomosis (EE).

Methods: Between January 1990 and March 2005, 94 patients underwent reconstructive surgery for IBDI: 49, Roux-Y HJ, and 45, EE.

Results: Early postoperative complications were observed in 12 (24.5%) patients undergoing HJ and three (6.7%) undergoing EE (p = 0.0239). Reoperations in the early postoperative period were performed in four (8%) patients after HJ and in zero patients after EE. Following HJ, one (2%) hospital death occurred due to acute circulatory insufficiency. Long-term results were evaluated in 69 (72%) patients. Postoperative mean weight gain was significantly higher after EE than HJ (p = 0.0191). Recurrent stricture was observed in two (5.3%) patients after HJ and three (9.6%) after EE (p = 0.6509). Terblanche long-term results were comparable in both groups (p = 0.3173). Good Karnofsky quality of life was comparable in both groups (p = 0.8377).

Conclusions: More early complications occurred after HJ than after EE. Long-term results were comparable after both reconstructive methods. After EE, patients achieved a higher weight gain than after HJ. Quality of life in both groups was comparable.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Roux-en-Y
  • Anastomosis, Surgical*
  • Bile Ducts / injuries*
  • Biliary Tract Surgical Procedures / methods*
  • Chi-Square Distribution
  • Female
  • Humans
  • Iatrogenic Disease
  • Jejunum / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Quality of Life
  • Reoperation
  • Retrospective Studies
  • Statistics, Nonparametric
  • Treatment Outcome