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World J Gastroenterol. Oct 14, 2013; 19(38): 6348-6352
Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6348
Hepatectomy for bile duct injuries: When is it necessary?
Beata Jabłońska
Beata Jabłońska, Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, 40-752 Katowice, Poland
Author contributions: Jabłońska B wrote this paper.
Correspondence to: Beata Jabłońska, MD, PhD, Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, Medyków 14 St, 40-752 Katowice, Poland. bjablonska@poczta.onet.pl
Telephone: +48-32-7894251 Fax: +48-32-7894251
Received: June 28, 2013
Revised: August 30, 2013
Accepted: September 3, 2013
Published online: October 14, 2013
Processing time: 109 Days and 15.8 Hours
Abstract

Iatrogenic bile duct injuries (IBDI) are still a challenge for surgeons. The most frequently, they are caused by laparoscopic cholecystectomy which is one of the commonest surgical procedure in the world. Endoscopic techniques are recommended as initial treatment of IBDI. When endoscopic treatment is not effective, surgery is considered. Different surgical biliary reconstructions are performed in most patients in IBDI. Roux-Y hepaticojejunostomy is the commonest biliary reconstruction for IBDI. In some patients with complex IBDI, hepatectomy is required. Recently, Li et al analyzed the factors that had led to hepatectomy for patients with IBDI after laparoscopic cholecystectomy (LC). Authors concluded that hepatectomy might be necessary to manage early or late complications after LC. The study showed that proximal IBDI (involving hepatic confluence) and IBDI associated with vascular injuries were the two independent risk factors of hepatectomy in this series. Authors distinguished two main groups of patients that require liver resection in IBDI: those with an injury-induced liver necrosis necessitating early intervention, and those in whom liver resection is indicated for treatment of liver atrophy following long-term cholangitis. In this commentary, indications for hepatectomy in patients with IBDI are discussed. Complex biliovascular injuries as indications for hepatectomy are presented. Short- and long-term results in patients following liver resection for IBDI are also discussed. Hepatectomy is not a standard procedure in surgical treatment of IBDI, but in some complex injuries it should be considered.

Keywords: Hepatectomy; Bile duct injury; Cholecystectomy; Laparoscopic cholecystectomy

Core tip: Different surgical biliary reconstructions are performed in most patients with iatrogenic bile duct injuries (IBDI). Roux-Y hepaticojejunostomy is the commonest biliary reconstruction. However, in some patients with complex IBDI involving disruption of hepatic confluence and injuries associated with concomitant vascular damage, hepatectomy is required. In this commentary, indications for hepatectomy in patients with IBDI are discussed. Complex biliovascular injuries as indications for hepatectomy are presented. Short- and long-term results in patients following liver resection for IBDI are also discussed. Hepatectomy is not a standard procedure in surgical treatment of IBDI, but in some complex injuries it should be considered.