Our Summary

This study looks at the results of additional surgeries needed for patients who have had a failed repair following a surgery to remove their gallbladder (cholecystectomy) that resulted in bile duct injuries (BDIs). The researchers looked back at cases from 2007 to 2020 and found that out of 262 patients who had a BDI repair, 66 needed additional surgery due to failure of the initial repair.

Most patients (85%) with a failed repair showed symptoms within five years of their repair attempt. The most common type of BDI was classified as E3. All patients had a specific type of surgery called Roux-en-Y hepaticojejunostomy.

After the surgery, about 35% of patients had complications, and the death rate was 1.5%. Patients stayed in the hospital for an average of 9 days after the surgery. Over the course of about 80 months, a small percentage (5.2%) of patients had issues with the surgical connection made during the procedure. Three patients died due to worsening liver disease.

However, the study found that 83% of patients had good or excellent long-term results, although this was lower than the 92.7% success rate for those who had successful initial repairs.

The researchers conclude that additional surgery is safe for patients who have had a failed repair after gallbladder removal and bile duct injury, and most patients can expect good long-term results. But the results are generally less successful than those who had successful initial repairs. The researchers suggest that earlier referral to a specialized unit for BDI repair might help improve long-term outcomes.

FAQs

  1. What was the median duration between the last attempt repair and the onset of recurrent symptoms in patients who underwent reoperative surgery for late failure of postcholecystectomy BDI repair?
  2. What was the most common type of Bile Duct Injury (BDI) observed in the study?
  3. How did the long-term results of patients who underwent reoperative surgery compare to those who underwent primary repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bile duct surgery is to follow postoperative instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding heavy lifting or strenuous activity. It is also important to communicate any new or worsening symptoms to your healthcare provider promptly. Following these recommendations can help ensure a successful recovery and long-term outcome.

Suitable For

Patients who are typically recommended bile duct surgery include those who have experienced late failure of postcholecystectomy bile duct injury repair. These patients may present with recurrent symptoms such as jaundice, abdominal pain, and fever. Bile duct injuries are classified based on the extent and severity of the injury, with E3 being the most common type. Reoperative surgery, such as Roux-en-Y hepaticojejunostomy, may be necessary to address the failed repair and achieve long-term clinical success. Patients with failed repair may experience postoperative complications, but overall the procedure is considered safe. It is important for these patients to be referred to a specialized unit for bile duct injury repair to improve long-term outcomes.

Timeline

  • Patient undergoes initial cholecystectomy for gallbladder disease
  • Patient develops symptoms of bile duct injury postoperatively
  • Patient undergoes initial repair for bile duct injury
  • Patient experiences late failure of initial repair
  • Patient undergoes reoperative surgery for late failure of repair
  • Median duration between last attempt repair and onset of recurrent symptoms is 18 months
  • 85% of patients with failed repair become symptomatic within 5 years
  • Roux-en-Y hepaticojejunostomy is performed in all patients
  • Postoperative complications develop in 35% of patients
  • Postoperative mortality rate is 1.5%
  • Median postoperative hospital stay is 9 days
  • 5.2% of patients develop clinically relevant anastomotic stricture during follow-up
  • Overall, 83% of patients achieve excellent or good long-term outcomes
  • Long-term results are less satisfactory in failed-repair group compared to primary repair patients.

What to Ask Your Doctor

Some questions a patient should ask their doctor about bile duct surgery include:

  1. What is the reason for my bile duct surgery?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the expected recovery time after the surgery?
  4. Will I need any additional procedures or treatments after the surgery?
  5. How experienced are you in performing this type of surgery?
  6. What are the success rates of this type of surgery for patients with my condition?
  7. What long-term outcomes can I expect after the surgery?
  8. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  9. What follow-up appointments or tests will be necessary after the surgery?
  10. Are there any alternative treatment options for my condition?

Reference

Authors: Ray S, Khamrui S, Ansari Z, Gupta A, Das S, Biswas J. Journal: Updates Surg. 2022 Oct;74(5):1543-1550. doi: 10.1007/s13304-022-01325-2. Epub 2022 Jul 16. PMID: 35840791