Long-term outcome and risk factors of failure after bile duct injury repair

Background: The real long-term outcome of a hepaticojejunostomy (HJ) to repair bile duct injury (BDI) is unclear, and the risk factors for repair failure are partially defined. Study Design: A retrospective, nonrandomized study of the long-term outcome of biliary reconstructions after major BDIs. All injuries occurred in association with cholecystectomy. Results: Twenty-nine patients were referred with complete transection of the common (n = 16), right (n = 5), or right sectoral (n = 4) hepatic ducts or of >1 major duct (n = 4) between October 2002 and January 2007. Mean follow-up was 24 months, range 12-60 months. Original repairs were "immediate" in 14, "delayed" (within 24-72h) in 5, and "elective" (after >8 weeks) in 10, and strictures developed in 9, 5, and 1 of those HJs, respectively. The surgical outcomes were significantly better when the intervention took place electively (p = 0.003). Original HJ repairs were done by a hepatobiliary surgeon (n = 23) or by a general surgeon (n = 6): the outcome was significantly better for the former (p < 0.001). Conclusions: The 51.7% incidence of strictures after BDI repair in this study was higher than reported in the literature, probably because of selection bias secondary to the referral pattern. The timing of repair and the surgeon's expertise are significant risk factors of failure.