Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Relationships of hepatic histopathological findings and bile microbiological aspects with bile duct injury repair surgical outcomes: A historical cohort

  • Guilherme Hoverter, Callejas (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP)) ;
  • Rodolfo Araujo Marques (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP)) ;
  • Martinho Antonio Gestic (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP)) ;
  • Murillo Pimentel Utrini (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP)) ;
  • Felipe David Mendonca Chaim (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP)) ;
  • Elinton Adami Chaim (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP)) ;
  • Francisco Callejas-Neto (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP)) ;
  • Everton Cazzo (Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP))
  • Received : 2022.01.18
  • Accepted : 2022.02.25
  • Published : 2022.11.30
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Abstract

Backgrounds/Aims: To analyze relationships of hepatic histopathological findings and bile microbiological profiles with perioperative outcomes and risk of late biliary stricture in individuals undergoing surgical bile duct injury (BDI) repair. Methods: A historical cohort study was carried out at a tertiary university hospital. Fifty-six individuals who underwent surgical BDI repair from 2014-2018 with a minimal follow-up of 24 months were enrolled. Liver biopsies were performed to analyze histopathology. Bile samples were collected during repair procedures. Hepatic histopathological findings and bile microbiological profiles were then correlated with perioperative and late outcomes through uni- and multi-variate analyses. Results: Forty-three individuals (76.8%) were females and average age was 47.2 ± 13.2 years; mean follow-up was 38.1 ± 18.6 months. The commonest histopathological finding was hepatic fibrosis (87.5%). Bile cultures were positive in 53.5%. The main surgical technique was Roux-en-Y hepaticojejunostomy (96.4%). Overall morbidity was 35.7%. In univariate analysis, liver fibrosis correlated with the duration of the operation (R = 0.3; p = 0.02). In multivariate analysis, fibrosis (R = 0.36; p = 0.02) and cholestasis (R = 0.34; p = 0.02) independently correlated with operative time. Strasberg classification independently correlated with estimated bleeding (R = 0.31; p = 0.049). The time elapsed between primary cholecystectomy and BDI repair correlated with hepatic fibrosis (R = 0.4; p = 0.01). Conclusions: Bacterial contamination of bile was observed in most cases. The degree of fibrosis and cholestasis correlated with operative time. The waiting time for definitive repair correlated with the severity of liver fibrosis.

Keywords

Acknowledgement

Rodolfo A. Marques was funded by a scholarship from the Institutional Scientific Initiation Scholarship Program - State University of Campinas (PIBIC - UNICAMP).

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