Optimal Time for Bile Duct Injury Reconstruction. Early Does Not Mean Better: a Multicenter Retrospective Analysis of a Hepato-pancreatic-biliary Group

Abstract Background Common bile duct injury it’s a severe and complex complication, and it’s related to increased rates of morbidity and mortality. Early recognition and on-time diagnosis plus multidisciplinary management led by a hepatobiliary surgeon show fewer complications rate and best postoperative outcomes. No guideline exists among the proper time of reconstruction. This study aims to describe the experience of a specialized Hepato-Pancreatic-Biliary (HPB) group and to analyze the outcomes regarding the time of bile duct injury (BDI) repair. Methods A multicenter retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent common bile duct reconstruction between January 2014 – December 2020 were included. Analysis and description of preoperative characteristics and postoperative outcomes were performed. A reconstruction time-based group differentiation was made and analyzed. Results 37 patients underwent common bile duct reconstruction between January 2014 and December 2020. 62.16% of the patients were female. The mean age was 50.4 years +/- 19.5 years. The most common injury was type E3 (29.73%). Hepaticojejunostomy was performed in 75.68% of the patients. Delayed reconstruction (> 72 hours) was performed in the majority of the cases (81.08%) due to delays in the referral centers. No statistically significant difference regarding complications in early or delayed BDI reconstruction. The mortality rate was 2.7% (n=1). 2-year follow-up bilioenteric stenosis was observed in 7 patients. Biloma showed a statistical relationship with complex bile duct injuries (p=0.02). Conclusion Common bile duct injury remains to be a concerning complication in general surgery. The multidisciplinary approach shows a lesser complication rate. The time of BDI reconstruction seems not to be a significant factor related to complications. In this study, biloma was associated with complex bile duct injury, However, further studies are needed to confirm our results.