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Background: Treatment of bile duct injuries (BDI) during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy. Methods: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0–7), intermediate (1–6 weeks) and late (6 weeks–6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality. Results: In total 913 patients from 48 centers were included in the analysis. In 401 patients (44%) the bile duct injury was diagnosed intraoperatively, and 126 patients (14%) suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37–8.65; p = 0.009). Conclusion: After BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable.

Biliary complications are still the major source of morbidity for liver transplant recipients. The reported incidence of biliary strictures is 5%-15% after deceased donor liver transplantation and 28%-32% after right-lobe live donor surgery. Presentation is usually within the first year, but the incidence is known to increase with longer follow-up. The anastomotic variant is due to technical factors, whereas the nonanastomotic form is due to immunological and ischemic events, which later may lead to graft loss. Endoscopic management of anastomotic strictures achieves a success rate of 70%-100%; it drops to 50%-75% for nonanastomotic strictures with a higher recurrence rate. Results of endoscopic maneuvers are disappointing for biliary strictures after live donor liver transplantation, and the success rate is 60%-75% for anastomotic strictures and 25%-33% for the nonanastomotic variant. Preventive strategies in the cadaveric donor include the standardization of the type of anastomosis and maintenance of a vascularized ductal stump. In right-lobe live donor livers, donor liver duct harvesting also involves a major risk. The concept of high hilar intrahepatic Glissonian dissection, dissecting the artery and the duct as one unit, use of microsurgical techniques for smaller ducts, use of ductoplasty, and flexibility in the performance of double ductal anastomosis are the critical components of the preventive strategies in the recipient. In the case of live donors, judicious use of intraoperative cholangiograms, minimal dissection of the hilar plate, and perpendicular transection of the duct constitute the underlying principals for obtaining a vascularized duct.

BACKGROUND/AIMS: Biliary stenting is the treatment of choice for inoperable cholangiocarcinomas of the hilum (Klatskin tumors). The aim of this study was to define factors predicting 1) successful biliary drainage and 2) survival. METHODOLOGY: This is a retrospective study of 48 patients with Bismuth's type I-II (n=15) and III-IV (n=33) strictures who were treated endoscopically (combined with percutaneous techniques if required), aiming to obtain complete resolution of jaundice. Prognostic variables for 1) successful drainage at 30 days and 2) survival at 12 months were analyzed. RESULTS: Drainage resulting in complete resolution of jaundice was obtained in 31/48 patients (65%). Baseline bilirubinemia was the only predicting factor of a successful drainage. Median survival was 202 days. The absence of a mass-type tumor or liver metastases, the absence of complications and successful drainage were identified as independent factors predicting survival at 12 months. Bilateral drainage with more than two stents was associated with a longer survival rate in patients with Bismuth III-IV tumors (271 versus 90 days) (p<0.050). CONCLUSIONS: In Klatskin tumors, resolution of jaundice through an optimal stenting results in a better survival rate. Additional independent predictive factors are the absence of a mass-type tumor, liver metastases and post-drainage complications., Journal Article, info:eu-repo/semantics/published

BACKGROUND/AIMS: Biliary stenting is the treatment of choice for inoperable cholangiocarcinomas of the hilum (Klatskin tumors). The aim of this study was to define factors predicting 1) successful biliary drainage and 2) survival. METHODOLOGY: This is a retrospective study of 48 patients with Bismuth's type I-II (n=15) and III-IV (n=33) strictures who were treated endoscopically (combined with percutaneous techniques if required), aiming to obtain complete resolution of jaundice. Prognostic variables for 1) successful drainage at 30 days and 2) survival at 12 months were analyzed. RESULTS: Drainage resulting in complete resolution of jaundice was obtained in 31/48 patients (65%). Baseline bilirubinemia was the only predicting factor of a successful drainage. Median survival was 202 days. The absence of a mass-type tumor or liver metastases, the absence of complications and successful drainage were identified as independent factors predicting survival at 12 months. Bilateral drainage with more than two stents was associated with a longer survival rate in patients with Bismuth III-IV tumors (271 versus 90 days) (p<0.050). CONCLUSIONS: In Klatskin tumors, resolution of jaundice through an optimal stenting results in a better survival rate. Additional independent predictive factors are the absence of a mass-type tumor, liver metastases and post-drainage complications., Journal Article, info:eu-repo/semantics/published

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