Ann Hepatobiliary Pancreat Surg.  2022 Nov;26(4):325-332. 10.14701/ahbps.22-003.

Relationships of hepatic histopathological findings and bile microbiological aspects with bile duct injury repair surgical outcomes: A historical cohort

Affiliations
  • 1Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil

Abstract

Backgrounds/Aims
To analyze relationships of hepatic histopathological findings and bile microbiological profiles with perioperative outcomes and risk of late biliary stricture in individuals undergoing surgical bile duct injury (BDI) repair.
Methods
A historical cohort study was carried out at a tertiary university hospital. Fifty-six individuals who underwent surgical BDI repair from 2014–2018 with a minimal follow-up of 24 months were enrolled. Liver biopsies were performed to analyze histopathology. Bile samples were collected during repair procedures. Hepatic histopathological findings and bile microbiological profiles were then correlated with perioperative and late outcomes through uni- and multi-variate analyses.
Results
Forty-three individuals (76.8%) were females and average age was 47.2 ± 13.2 years; mean follow-up was 38.1 ± 18.6 months. The commonest histopathological finding was hepatic fibrosis (87.5%). Bile cultures were positive in 53.5%. The main surgical technique was Roux-en-Y hepaticojejunostomy (96.4%). Overall morbidity was 35.7%. In univariate analysis, liver fibrosis correlated with the duration of the operation (R = 0.3; p = 0.02). In multivariate analysis, fibrosis (R = 0.36; p = 0.02) and cholestasis (R = 0.34; p = 0.02) independently correlated with operative time. Strasberg classification independently correlated with estimated bleeding (R = 0.31; p = 0.049). The time elapsed between primary cholecystectomy and BDI repair correlated with hepatic fibrosis (R = 0.4; p = 0.01).
Conclusions
Bacterial contamination of bile was observed in most cases. The degree of fibrosis and cholestasis correlated with operative time. The waiting time for definitive repair correlated with the severity of liver fibrosis.

Keyword

Cholecystectomy; Iatrogenic disease; Cholangitis; Bile duct diseases; Cholestasis

Figure

  • Fig. 1 Flowchart of the study population.


Cited by  1 articles

Comment on: “Relationships of hepatic histopathological findings and bile microbiological aspects with bile duct injury repair surgical outcomes: A historical cohort”
Srikanth Gadiyaram, Murugappan Nachiappan
Ann Hepatobiliary Pancreat Surg. 2023;27(1):120-121.    doi: 10.14701/ahbps.27-1-L.


Reference

1. Reynolds W Jr. 2001; The first laparoscopic cholecystectomy. JSLS. 5:89–94.
2. Pucher PH, Brunt LM, Davies N, Linsk A, Munshi A, Rodriguez HA, et al. 2018; Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 32:2175–2183. DOI: 10.1007/s00464-017-5974-2. PMID: 29556977. PMCID: PMC5897463.
3. Renz BW, Bösch F, Angele MK. 2017; Bile duct injury after cholecystectomy: surgical therapy. Visc Med. 33:184–190. DOI: 10.1159/000471818. PMID: 28785565. PMCID: PMC5527188.
4. Boerma D, Rauws EA, Keulemans YC, Bergman JJ, Obertop H, Huibregtse K, et al. 2001; Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg. 234:750–757. DOI: 10.1097/00000658-200112000-00006. PMID: 11729381. PMCID: PMC1422134.
5. Hariharan D, Psaltis E, Scholefield JH, Lobo DN. 2017; Quality of life and medico-legal implications following iatrogenic bile duct injuries. World J Surg. 41:90–99. DOI: 10.1007/s00268-016-3677-9. PMID: 27481349.
6. Berney CR. 2012; Major common bile duct injury and risk of litigation: a surgeon's perspective. Am J Surg. 204:800–802. DOI: 10.1016/j.amjsurg.2011.06.009. PMID: 21872206.
7. Fong Z, Pitt H, Strasberg S, Loehrer A, Sicklick J, Talamini M, et al. 2018; Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. J Am Coll Surg. 226:568–576.e1. DOI: 10.1016/j.jamcollsurg.2017.12.023. PMID: 29307612. PMCID: PMC6053912.
8. Schreuder A, Busch O, Besselink M, Ignatavicius P, Gulbinas A, Barauskas G, et al. 2020; Long-term impact of iatrogenic bile duct injury. Dig Surg. 37:10–21. DOI: 10.1159/000496432. PMID: 30654363. PMCID: PMC7026941.
9. Bansal V, Krishna A, Misra M, Prakash P, Kumar S, Rajan K, et al. 2015; Factors affecting short-term and long-term outcomes after bilioenteric reconstruction for post-cholecystectomy bile duct injury: experience at a tertiary care centre. Indian J Surg. 77(Suppl 2):472–479. DOI: 10.1007/s12262-013-0880-x. PMID: 26730048. PMCID: PMC4692855.
10. Ekmekcigil E, Ünalp Ö, Uğuz A, Hasanov R, Bozkaya H, Köse T, et al. 2018; Management of iatrogenic bile duct injuries: Multiple logistic regression analysis of predictive factors affecting morbidity and mortality. Turk J Surg. 34:264–270. DOI: 10.5152/turkjsurg.2018.3888. PMID: 30216168. PMCID: PMC6340667.
11. Koffron A, Ferrario M, Parsons W, Nemcek A, Saker M, Abecassis M. 2001; Failed primary management of iatrogenic biliary injury: incidence and significance of concomitant hepatic arterial disruption. Surgery. 130:722–728. discussion 728–731. DOI: 10.1067/msy.2001.116682. PMID: 11602904.
12. Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW. 2004; Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg. 8:523–530. discussion 530–531. DOI: 10.1016/j.gassur.2004.02.010. PMID: 15239985.
13. Stewart L, Way LW. 2009; Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB (Oxford). 11:516–522. DOI: 10.1111/j.1477-2574.2009.00096.x. PMID: 19816617. PMCID: PMC2756640.
14. Flores-Rangel G, Chapa-Azuela O, Rosales A, Roca-Vasquez C, Böhm-González S. 2018; Quality of life in patients with background of iatrogenic bile duct injury. World J Surg. 42:2987–2991. DOI: 10.1007/s00268-018-4564-3. PMID: 29520485.
15. O'Brien S, Wei D, Bhutiani N, Rao MK, Johnston SS, Patkar A, et al. 2020; Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy. Surg Endosc. 34:628–635. DOI: 10.1007/s00464-019-06809-8. PMID: 31286250.
16. Roy P, Soonawalla Z, Grant H. 2009; Medicolegal costs of bile duct injuries incurred during laparoscopic cholecystectomy. HPB (Oxford). 11:130–134. DOI: 10.1111/j.1477-2574.2008.00023.x. PMID: 19590636. PMCID: PMC2697871.
17. Würstle S, Göß A, Spinner CD, Huber W, Algül H, Schlag C, et al. 2019; A retrospective clinical and microbial analysis of 32 patients with bilomas. BMC Gastroenterol. 19:50. DOI: 10.1186/s12876-019-0968-2. PMID: 30947689. PMCID: PMC6450004.
18. Gu XX, Zhang MP, Zhao YF, Huang GM. 2020; Clinical and microbiological characteristics of patients with biliary disease. World J Gastroenterol. 26:1638–1646. DOI: 10.3748/wjg.v26.i14.1638. PMID: 32327912. PMCID: PMC7167412.
19. Negi SS, Sakhuja P, Malhotra V, Chaudhary A. 2004; Factors predicting advanced hepatic fibrosis in patients with postcholecystectomy bile duct strictures. Arch Surg. 139:299–303. DOI: 10.1001/archsurg.139.3.299. PMID: 15006888.
20. Abdel-Aziz G, Lebeau G, Rescan PY, Clément B, Rissel M, Deugnier Y, et al. 1990; Reversibility of hepatic fibrosis in experimentally induced cholestasis in rat. Am J Pathol. 137:1333–1342.
21. Soares PFDC, Gestic MA, Utrini MP, Callejas-Neto F, Chaim EA, Cazzo E. 2019; Epidemiological profile, referral routes and diagnostic accuracy of cases of acute cholangitis among individuals with obstructive jaundice admitted to a tertiary-level university hospital: a cross-sectional study. Sao Paulo Med J. 137:491–497. DOI: 10.1590/1516-3180.2019.0109170919. PMID: 32159634.
22. Pellegrini C, Thomas M, Way L. 1984; Recurrent biliary stricture. Patterns of recurrence and outcome of surgical therapy. Am J Surg. 147:175–180. DOI: 10.1016/0002-9610(84)90054-0. PMID: 6691544.
23. Pottakkat B, Vijayahari R, Prakash A, Singh RK, Behari A, Kumar A, et al. 2010; Factors predicting failure following high bilio-enteric anastomosis for post-cholecystectomy benign biliary strictures. J Gastrointest Surg. 14:1389–1394. DOI: 10.1007/s11605-010-1241-8. PMID: 20589447.
24. Mitsunaga TM, Jimenez LS, Soares PFDC, Gestic MA, Utrini MP, Chaim FDM, et al. 2021; Effect of transient obstructive cholestasis on liver histology: a cross-sectional study. Sao Paulo Med J. 139:351–363. DOI: 10.1590/1516-3180.2020.0536.r1.1502021. PMID: 34161522. PMCID: PMC9615596.
25. Ismael H, Cox S, Cooper A, Narula N, Aloia T. 2017; The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford). 19:352–358. DOI: 10.1016/j.hpb.2016.12.004. PMID: 28189346.
26. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. 1999; Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 134:36–42. DOI: 10.1001/archsurg.134.1.36. PMID: 9927128.
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