Factors leading to loss of patency after biliary reconstruction of major laparoscopic cholecystectomy bile duct injuries: an observational study with long-term outcomes.

BACKGROUND: Small sample size and a lack of standardized reporting for patients requiring reconstruction for laparoscopic cholecystectomy bile duct injuries (LC-BDI) have limited investigation of factors contributing to loss of patency. METHODS: Using a prospective database, patient characteristics, pre-repair investigations, Strasberg-Bismuth level of injury, timing of reconstruction and postoperative complications were compared in successful index reconstruction and revision patients. Multivariate analysis was performed to determine independent predictors of loss of patency. RESULTS: Of 131 patients analysed, 103 had a successful index reconstruction and 28 required revision. There were no statistically significant differences in patient characteristics between the two groups. Days to referral and reconstruction were significantly different (p < 0.001, p = 0.001). Patients with incomplete biliary imaging more often required a revision (p < 0.001). The only independent predictor of loss of patency was incomplete depiction of the biliary tree prior to initial reconstruction (p = 0.035, OR 10.131, 95% CI 1.180-86.987). Primary and secondary patency were 98.1% and 96.4%, respectively with no differences in 30-day complications. CONCLUSIONS: Incomplete depiction of LC-BDI before index reconstruction was independently associated with loss of patency requiring revision. Despite the complexity of repeat biliary reconstruction, outcomes in an HPB unit were similar to that of an index reconstruction.