Evidence-Based Medicine
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World J Gastroenterol. Jun 14, 2014; 20(22): 6924-6931
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6924
Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes
Young Ook Eum, Joo Kyung Park, Jaeyoung Chun, Sang-Hyub Lee, Ji Kon Ryu, Yong-Tae Kim, Yong-Bum Yoon, Chang Jin Yoon, Ho-Seong Han, Jin-Hyeok Hwang
Young Ook Eum, Department of Internal medicine, Cheongju St. Mary's Hospital, Chungcheongbuk-do 360-568, South Korea
Joo Kyung Park, Jaeyoung Chun, Ji Kon Ryu, Yong-Tae Kim, Yong-Bum Yoon, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, South Korea
Sang-Hyub Lee, Jin-Hyeok Hwang, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea
Chang Jin Yoon, Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea
Ho-Seong Han, Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, South Korea
Author contributions: Eum YO and Park JK equally contributed to this work as first authors; Eum YO, Park JK and Hwang JH designed the research; Eum YO, Park JK, Chun JY, Lee SH, Yoon CJ and Han HS performed research; Eum YO, Park JK, Hwang JH analyzed data and drafted article; Ryu JK, Kim YT, Yoon YB and Hwang JH revised the paper with critically important intellectual content; Eun YO and Park JK wrote the paper.
Correspondence to: Jin-Hyeok Hwang, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do 463-707, South Korea. pdoctor7@snu.ac.kr
Telephone: +82-31-7877017 Fax: +82-31-7874051
Received: September 29, 2013
Revised: January 5, 2014
Accepted: February 17, 2014
Published online: June 14, 2014
Abstract

AIM: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).

METHODS: The study patients were enrolled from the pancreatobiliary units of a tertiary teaching hospital for the treatment of BDIs after hepatobiliary tract surgeries, excluding operations for liver transplantation and malignancies, from January 1999 to August 2010. A total of 5167 patients underwent operations, and 77 patients had BDIs following surgery. The primary end point was the treatment success rate according to different types of BDIs sustained using endoscopic or percutaneous hepatic approaches. The type of BDI was defined using one of the following diagnostic tools: endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography scan, and magnetic resonance cholangiography. Patients with a final diagnosis of BDI underwent endoscopic and/or percutaneous interventions for the treatment of bile leak and/or stricture if clinically indicated. Patient consent was obtained, and study approval was granted by the Institutional Review Board in accordance with the legal regulations of the Human Clinical Research Center at the Seoul National University Hospital in Seoul, South Korea.

RESULTS: A total of 77 patients were enrolled in the study. They were divided into three groups according to type of BDI. Among them, 55 patients (71%) underwent cholecystectomy. Thirty-six patients (47%) had bile leak only (type 1), 31 patients had biliary stricture only (type 2), and 10 patients had both bile leak and biliary stricture (type 3). Their initial treatment modalities were non-surgical. The success rate of non-surgical treatment in each group was as follows: BDI type 1: 94%; type 2: 71%; and type 3: 30%. Clinical parameters such as demographic factors, primary disease, operation method, type of operation, non-surgical treatment modalities, endoscopic procedure steps, type of BDI, time to diagnosis and treatment duration were evaluated to evaluate the prognostic factors affecting the success rate. The type of BDI was a statistically significant prognostic factor in determining the success rate of non-surgical treatment. In addition, a shorter time to diagnosis of BDI after the operation correlated significantly with higher success rates in the treatment of type 1 BDIs.

CONCLUSION: Endoscopic or percutaneous hepatic approaches can be used as an initial treatment in type 1 and 2 BDIs. However, surgical intervention is a treatment of choice in type 3 BDI.

Keywords: Endoscopic retrograde cholangiography, Percutaneous transhepatic cholangiography, Percutaneous transhepatic biliary drainage, Bile duct, Biliary stricture.

Core tip: It is not unusual to encounter patients with post-operative bile duct injuries (BDIs) in the setting of a specialized biliary clinic at tertiary hospitals. With regard to the patients’ best interests, it is important to determine the suitability of non-invasive treatment. We analyzed the clinical outcomes and various prognostic factors that affected the success rates of non-surgical treatments. The BDI type was the single most powerful factor that determined the success rate of non-surgical treatment. In addition, we emphasize that this series of 77 patients with post-operative BDI was one of the largest series of this type to be examined.