Factors associated with patency loss and actuarial patency rate following post-cholecystectomy bile duct injury repair:
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ORIGINAL ARTICLE
Factors associated with patency loss and actuarial patency rate following post-cholecystectomy bile duct injury repair: long-term follow-up Gustavo Martínez-Mier 1,2,3
&
Pedro I. Moreno-Ley 1,2 & Daniel Mendez-Rico 4
Received: 7 July 2020 / Accepted: 2 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Several factors may contribute to bile duct injury (BDI) repair failure. The objective of our study was to evaluate factors that contribute to the loss of patency and influence the actuarial patency rate of BDI repairs in an 11-year period. Methods Retrospective review study of patients who underwent a hepaticojejunostomy for a type E Bismuth-Strasberg BDI (2008-2019). The outcomes are the following: primary patency attained, loss of primary patency, and actuarial primary patency rate. Logistic regression for loss of patency and Cox regression for actuarial patency rate were used. Results Seventy-nine patients (age 42.3 ± 15.8 years, 81% female) were studied. Most common index operation was open cholecystectomy (60.8%). Most common Bismuth-Strasberg lesion was E4 (38%). Primary patency was 93.4%. Mean followup was 36 ± 34 months. Ten-year actuarial patency was 53.9%. Factors associated with loss of patency were vasculobiliary injury, biliary stents, and 90-day biliary complications (univariate); number of surgeries before repair and postoperative cholangitis (univariate and multivariate) (p < 0.05). Factors that impacted actuarial patency rate were (univariate analysis) 90day biliary complications; postoperative cholangitis and index treatment period stenosis (p < 0.05). No factors impacted actuarial patency rate in multivariate analysis. Conclusion Postoperative cholangitis is associated with loss of patency and had potentially detrimental effect on the actuarial patency rate in BDI repair. Keywords Bile duct injury . Hepaticojejunostomy . Outcomes . Risk factors . Failure
* Gustavo Martínez-Mier [email protected]; [email protected]; [email protected] Pedro I. Moreno-Ley [email protected] Daniel Mendez-Rico [email protected] 1
Organ Transplantation and General Surgery, IMSS UMAE Hospital de Especialidades 14 “Adolfo Ruiz Cortines”, Cuauhtemoc S/N Formando Hogar, 91897 Veracruz, Veracruz, Mexico
2
Organ Transplantation and General Surgery, SESVER Hospital de Alta Especialidad “Virgilio Uribe” 20 de Noviembre 1074 Centro, 91700 Veracruz, Veracruz, Mexico
3
Corporativo San Gabriel, Alacio Perez 928-314. Fracc. Zaragoza, 91910 Veracruz, Veracruz, Mexico
4
General Surgery. IMSS UMAE Hospital de Especialidades 14 “Adolfo Ruiz Cortines”, Cuauhtemoc S/N Formando Hogar, 91897 Veracruz, Veracruz, Mexico
Introduction Bile duct injury (BDI) is a serious and complex complication after cholecystectomy The incidence of BDI varies from 0.3 to 1.5% based on the population studied [1, 2]. A major BDI may affect the patient’s health and quality of life for years, even after successful treatment [3, 4]. Several factors that may contribute to
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