Long-Term Results of Large Diameter Hepaticojejunostomy for Treatment of Bile Duct Injuries Following Cholecystectomy
Thawatchai Akaraviputh MD*, Wiroon Boonnuch MD*, Varut Lohsiriwat MD*, Asada Methasate MD, PhD*, Vitoon Chinswangwatanakul MD, PhD*, Narong Lert-akayamanee MD*, Darin Lohsiriwat MD*
Affiliation : * The Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Objective : Bile Duct Injury (BDI) is one of the most serious complications of cholecystectomy. The authors
analyzed the clinical presentation, surgical management and long-term outcome of 19 patients presenting
with iatrogenic major BDIs (Straburg type E) following cholecystectomy who underwent Roux-en-Y
hepaticojejunostomy.
Materials and Methods : Between 1992 and 2005, 19 patients with major BDIs (Strasberg type E) following
cholecystectomy were included. Operative notes and charts of all patients were reviewed systematically. A
follow-up examination of each patient was performed after a median of 22 months (range 1-120).
Results : Twelve patients presented with ascending cholangitis, two patients were referred to the hospital with
biliary-cutaneous fistula and five patients (26.3%) were identified at the time of operations. All patients were
treated with Roux-en-Y hepaticojejunostomy with at least 2 cm of the diameter of the biliary-enteric anastomo-
sis. There was no postoperative mortality. Postoperative complication was found in 5 patients (26.3%). Until
now, during the follow-up, neither clinical nor biochemical evidence of recurrent cholangitis has been found.
Conclusion : Major BDIs are associated with high morbidity rate and prolonged hospitalization. Early detec-
tion and referral to an experienced center is crucial in the management of these patients. Roux-en-Y
hepaticojejunostomy with large diameter of the biliary-enteric anastomosis is the surgical procedure of choice
with good long-term outcome.
Keywords : Bile duct injury, Cholecystectomy, Hepaticojejunostomy
