Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2102-2107
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2102
Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury
Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello
Marcos V Perini, Paulo Herman, Andre L Montagnini, Jose Jukemura, Fabricio F Coelho, Jaime A Kruger, Telesforo Bacchella, Ivan Cecconello, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil
Author contributions: Perini MV and Herman P designed the study, Perini MV collected the data and wrote the paper; Herman P, Montagnini AL, Jukemura J, Coelho FF, Kruger JA, Bacchella T and Cecconello I reviewed the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marcos V Perini, MD, PhD, Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo Medical School, 455Av Dr Eneas de Carvalho Aguiar, Sao Paulo 05403-000, Brazil. marcos.perini@usp.br
Telephone: +55-11-26616214 Fax: +55-11-26617560
Received: August 3, 2014
Peer-review started: August 4, 2014
First decision: August 27, 2014
Revised: September 25, 2014
Accepted: November 30, 2014
Article in press: December 1, 2014
Published online: February 21, 2015
Abstract

AIM: To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular injury.

METHODS: From a prospective database of patients treated for benign biliary strictures at our hospital, cases that underwent liver resections were reviewed. All cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy (open or laparoscopic). Liver resection was indicated in patients with Strasberg E3/E4 (hilar stricture) bile duct lesions associated with vascular damage (arterial and/or portal), ipsilateral liver atrophy/abscess, recurrent attacks of cholangitis, and failure of previous hepaticojejunostomy.

RESULTS: Of 148 patients treated for benign biliary strictures, nine (6.1%) underwent liver resection; eight women and one man with a mean age of 38.6 years. Six patients had previously been submitted to open cholecystectomy and three to laparoscopic surgery. The mean number of surgical procedures before definitive treatment was 2.4. All patients had Strasberg E3/E4 injuries, and vascular injury was present in all cases. Eight patients underwent right hepatectomy and one underwent left lateral sectionectomy without mortality. Mean time of follow up was 69.1 mo and after long-term follow up, eight patients are asymptomatic.

CONCLUSION: Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed.

Keywords: Abscess, Atrophy, Benign, Bile ducts, Cholecystectomy, Hepatectomy, Stenosis, Vascular system injury

Core tip: Bile duct injury is a major concern due to its complex treatment and long-term complication rate. Associated vascular injury most commonly occurs during cholecystectomy, but can also occur during bile duct repair. Definitive treatment procedures are challenging due to the association of bile duct and vascular injuries. We describe our experience in treating these complex patients. Liver resection was reserved for patients with Strasberg E3/E4 (hilar stricture) bile duct lesions associated with vascular damage (arterial and/or portal), ipsilateral liver atrophy/abscess, recurrent attacks of cholangitis, and failure of the previous hepaticojejunostomy.