Feasibility of delayed vascular repair after surgical combined injury to the bile duct and hepatic artery: case series and systematic review

Abstract

Background: Concomitant vascular injury to the hepatic artery (HA) can adversely impact outcomes after iatrogenic bile duct injury (IBDI) during cholecystectomy. An emergency attempt to reconstruct the artery is usually recommended as it is thought to avoid serious biliary and hepatic complications. However, the feasibility of delayed reconstruction of the HA is uncertain to date. Methods: First, we present a retrospective case series comprising of 6 consecutive patients who underwent delayed surgical repair of the HA after IBDI in addition to bile duct reconstruction. The patency of the HA and clinical outcomes were assessed postoperatively. Second, we provide a systematic review (SR) on this topic utilizing EMBASE, Medline/PubMed, Cochrane und Scopus databases. Results: The arteries of all 6 patients were successfully reconstructed on average 5 days after injury (range 1-10). The types of injuries included in all cases the right HA and in one case an additional injury to the proper HA. All arteries were patent at the last follow-up (mean 27 months, range 3-72). After reconstruction, one patient suffered from a stricture of the hepatico-jejunostomy. In the SR, we identify case series that report the success rates of late vascular repair and support our clinical findings. Conclusion: Delayed vascular repair of concomitant injury to the HA after IBDI appears feasible, results in long-term vessel patency and provides a viable alternative to early vascular reconstruction.