Risk Factors and Predictors of Poor Outcome Following Hepaticojejunostomy for Postcholecystecomy Bile Duct Injury

Bilio-enteric anastomosis is the main line of treatment of bile duct injury (BDI). This study aims at exploring factors related to poor outcome after surgical reconstruction especially operative factors. Special emphasis on Hepp-Couinaud technique, theoretically, ensuring larger stoma and better blood supply. Between January 1992 and July 2015, 321 cases of postcholecystectomy BDI underwent hepaticojejunostomy. Retrospective analysis of demographics, perioperative data and management, and outcome according to Terblanche et al. Development of anastomotic strictures (AS) was evaluated. The mean follow-up time was 84.7 ± 61.9 months. Women represented 76% of all cases with a mean age of 40.1 ± 12.8. ERCP was performed in 105 (32.7%) patients. E2 and E3 strictures accounted for 76% of cases. One hundred thirty-seven (42.7%) patients underwent an end-to-side HJ. Abdominal collection or biloma was the commonest complication. Anastomotic stricture occurred in 16 (5.2%) patients after a mean time of 45 ± 31.3 months. Excellent or good outcome was detected in 281 (91.8%) patients, while fair or poor outcome was proved in 25 (8.2%) patients. On multivariate analysis, the only significant factors that predict a poor outcome were post-ERCP pancreatitis (p = 0.008), the design of HJ as end to side (p = 0.033), and postoperative biloma or abdominal collection (p = 0.021). On multivariate analysis, the only factor that was found to significantly affect the development of AS was postoperative development of collection or biloma (p = 0.032). HJ has very good results in specialized centers. Careful operative technique with sound wide stoma improves the outcome. ERCP should be used selectively and with caution for diagnosis of biliary strictures.