Longterm outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study

BackgroundThe aim of this retrospective study was to evaluate the perioperative and longterm outcome after early repair with a hepaticojejunostomy (HJ).MethodsBetween 1995 and 2010, a nationwide, retrospective multicentre study was conducted. All iatrogenic bile duct injury (BDI) sustained during a cholecystectomy and repaired with HJ in the five HepatoPancreaticoBiliary centres in Denmark were included.ResultsIn total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Postoperative morbidity was 36% and mortality was 4%. Fortytwo patients (30%) had a stricture of the HJ. The median followup time without stricture was 102 months. Nineteen out of the 42 patients with postreconstruction biliary strictures had a reHJ. Twentythree patients were managed with percutaneous transhepatic cholangiography and dilation. The overall success rate of reestablishing the biliodigestive flow approached 93%. No association was found between timing of repair, concomitant vascular injury, level of injury and stricture formation.ConclusionIn this national, unselected and consecutive cohort of patients with BDI repaired by early HJ we found a considerable risk of longterm complications (e.g. 30% stricture rate) and mortality in both the short and the longterm perspective.