| Objective:The long-tern outcome of surgical repair for laparoscopic cholecystectomy-related bile duct injury(LC-BDI)classified as Strasberg E1-E4 were retrospectively.The aim of this article is to evaluate the rational method for common type LC-BDI repairMethods:We Retrospectively analyzed the clinical data and out-come that followed up for more than 2 years of 115 cases of LC-BDI witch occurred in or referred to Kunming General Hospital of PLA between January 1993 to January 2016.Four cases of LC-BDI witch not correspond to the standard were excluded,and 111 cases of LC-BDI were analyzed in this group.The clinical data included:the records of the original laparoscopic cholecystectomy(LC),and the records of the definitive repair.The post-repair outcome assessment was classified as grade ?-? according to the Terblanche's grade,the grade ? and ? were considered as success,and the grade ?and ? were failure.Strasberg BDI classification system is used to classify 115 cases of BDI into Strasberg A,B,C,D,andEl-E5 type.Because StrasbergA-D and E5 had a remarkable variety of injury severity at the given injury level,and in order to facilitate compareation and analysis of the results,only bile ducts typed Strasberg E1-E4 were analyzed in this group.BDI is defined as low BDI while E2-E4 typed BDI is defined as high BDI,The proportion of different BDI type in this group was calculated.Based on the distance between the reconstructed level and the injury level,the reconstruction procedure is defined as high repair or repair in-situ.repair in-situ means reconstruction is performed at the level less than 1cm proximal to injury level.Respectively,high repair means reconstruction is carried out at the level more than 1cm proximal to the injury level.Patients were followed up through outpatient check-ups,telephone,e-mail and WeChat.Time of follow-up was 25-300months,median follow-up was 110.2 months.Results of follow-up were analyzed in detail.For failed repairs,the techniques for next reconstruction and outcomes were records as described previously.Results:1.In this group,93 cases were high BDI,accounting for 83.8%(93/111),94.6%(88/93)of them were E2 and E3 BDI2.In 49 cases of BDI witch adopted high repair as original definitive repair,forty-five cases were successfully repaired,the success rate was 91.8%(45/49),including 7 low BDI cases,five of 7 the cases repaired successfully,the success rate was 71.4%(5/7),42 cases were high BDI,forty of the 42 cases repaired successfully,the success rate was 95.2%(40/42).In high repair cases,the success rate of high BDI repair was slightly higher than that of low BDI,but the difference was not statistically significant(p>0.05).3.In 62 cases of BDI witch adopted repair in-situ as original definitive repair,thirty-seven cases were successfully repaired,the success rate was 59.7%(37/62),including 51 cases were high BDI,thirty-one of the 51 cases were successfully repaired,the success rate was 60.8%(31/51),11 cases were low DBI cases,six of the 11 cases successfully repaired,the success rate was 54.5%(6/11).In the case of repair in-situ,there was no significant difference in the success rate of high BDI and low BDI repair(p>0.05).4.62 BDI cases used repair in-situ as the first definiteness repair,thirty-seven of the cases were successfully repaired,the success rate of repair was 59.7%(37/62).49 BDI cases used high repair as the first definiteness repair,forty-five of the cases were successfully repaired,and the success rate of repair was 91.8%(45/49).The success rate of high repair was higher than repair in-situ,and the difference was statistically significant(p<0.05).5.28 cases of BDI repair were failed after the first definitive repair,all of them were treated with reoperation.Techniques for reoperation were all high repair.The success rate of reoperation was 89.3%(25/28).Conclusion:1.In the case of the experience of LC-BDI operator is constant.the success rate of high repair is significantly higher than that of repair in-situ.2.The injury level of LC-BDI cannot decisively affect the long-term outcome after a reasonable repair.For a simple low BDI,a high repair failure rate can be observed after an inappropriate surgical repair,however,when the repair technique rationally applied,a satisfactory repair success rate can be got even for a complex high BDI. |
PDF Full Text Request