Hepatectomy and liver transplant after cholecystectomy: Systemic review

Abstract

Presenter: Osamu Yoshino MD | Austin Health and University of Melbourne Background: Bile duct injury (BDI) after cholecystectomy remains a substantial problem in gallbladder surgery. Despite advancement in modern surgical technique, the BDI rate has remained steady over time since the 1990s. Although most cases can be successfully managed by hepaticojejunostomy, few cases with complex BDI would require hepatectomy (HT) and/or liver transplantation (LT). Those indications and outcomes are little described in the literature. Methods: A systematic review of the literature was performed by searching Medline/PubMed, Scopus and Cochrane databases. Timings of surgery were categorized into early (within 12 months from BDI) and late (12 months after BDI). Results: 179 studies were screened for relevance and 32 studies were selected. There were 2157 BDI and 163 hepatectomies (7.5 %) and 68 liver transplants (3.1%) were identified among those patients. The most common non-surgical intervention was endoscopic stenting and the most common surgery was hepaticojejunostomy. The indications for HT were mostly recurrent cholangitis and liver abscess. The most common indication for LT was secondary biliary cirrhosis. BDIs submitted to early surgery were associated with major vascular injuries (hepatic artery and portal vein) leading to liver failure and the need for a liver transplant. Reported mortalities are 22 (13.4%) and 6 (8.8%) cases, respectively in HT and LT. Conclusion: HT and LT are seldomly required after BDI and the indications were mostly concomitant vascular injury, leading to acute liver failure or, chronic infective complications including abscess, recurrent cholangitis and secondary biliary cirrhosis. Early recognition of major vascular in the setting of BDI and referral to a Tertiary centre is imperative for a better outcome.