Analysis Of Risk Factors For Short-term And Long-term Complications After Iatrogenic Bile Duct Injury

Objective Iatrogenic bile duct injury(IBDI)is a serious complication of biliary tract surgery,and some IBDIs need to be repaired with hepaticojejunostomy(HJ).The purpose of this study was to analyze the short-term and long-term results after HJ treatment for IBDI.To determine the risk factors of short-term complications and long-term biliary stricture.Analyze the quality of life of long-term patients after surgery.Methods This study retrospectively analyzed 110 cases of IBDI who underwent HJ in the Second Affiliated Hospital of Anhui Medical University,the First Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital from January 2001 to December2018,and all patients were try to followe up.Univariate and multivariate analyses were performed to explore the related risk factors that affect short-term complications and long-term biliary stricture after surgery.The quality of life of patients before cholecystectomy,during IBDI and follow-up were compared and analyzed.Results(1)A total of 110 IBDI patients underwent HJ repair,with a median age of 44years(IQR 36-57 years).The short-term postoperative complication rate was 35.5%(n= 39)and the serious complication rate was 17.3%(n = 19).Univariate analysis showed that males(P = 0.016),surgical repair before referral(P = 0.025),intraoperative bleeding> 400ml(P = 0.023),and duration of surgery(P = 0.034)were significantly associated with recent postoperative complications.Related.Multivariate analysis showed males(OR 0.258,95% CI [0.091;0.730],P = 0.011),surgical repair before referral(OR 7.614,95% CI [1.845;31.421],P = 0.005),preoperative biliary leak(OR5.925,95% CI [1.536;22.853],P = 0.010),combined partial liver resection(OR 44.159,95% CI [2.444;797.779],P = 0.010),and intraoperative bleeding> 400ml(OR 17.028,95 % CI [2.179;133.104],P = 0.007)is an independent risk factor affecting the recent complications after surgery.(2)A total of 90 IBDI patients were successfully followed up with a median follow-up time of 104 months(IQR 57-129 months).Fourteen patients(15.6%)had long-term anastomotic stenosis.At the end of the follow-up,most patients(68.9%)showed good results with Terblanche ≥ grade III.Univariate analysis showed that in univariate analysis,only severe postoperative complications(Clavien-Dindo: grade III-IV)were associated with anastomotic stenosis(P = 0.034).There were no independent risk factors related to long-term anastomosis stenosis in the multivariate analysis(all P> 0.05).(3)45 patients completed a quality of life questionnaire.During IBDI,only a few patients reported good physical activity(24.4%),good emotional state(35.5%),and general health(26.6%).After bile-enteric anastomosis,quality of life was significantly improved during the follow-up period:good physical activity(93.3%),good emotional state(91.1%),and general health(93.3%)(both p <0.05)Return to pre-cholecystectomy status: good physical activity(95.5%),good emotional state(82.2%),and general health(84.4%)(both p> 0.05).Conclusion(1)For IBDI after cholecystectomy,HJ surgery is a safe and reliable treatment.After the occurrence of IBDI,the original surgeon should avoid blindly performing surgical repair.Early referral to a specialist experienced hepatobiliary surgery center is the best choice.(2)If bile leakage persists before surgery,adequate bile drainage should be given priority to control infection.When sepsis is present before surgery,secondary surgical repair after infection control is the best option.(3)Compared with the period of IBDI,the quality of life of patients with IBDI during follow-up was also significantly improved,and they were able to return to the state before cholecystectomy.