Transplantation hépatique pour plaie iatrogène des voies biliaires post-cholécystectomie : étude rétrospective multicentrique nationale française

Abstract : Introduction: iatrogenic bile duct injury is a potentially severe complication of cholecystectomy : high morbidity and mortality, many hospitalisations and surgeries, even liver transplantation. The purpose of this study was to determinate risk factors of transplantation after bile duct injury, and to analyse failures. Methods: french national observational study, descriptive, retrospective and multicentric. Every liver transplant patient in France between 01/01/1994 and 12/31/2017, following bile duct injury during cholecystectomy, regardless of the approach, was included. Results: 30 patients were included, with a 0,73 sex ratio (11 men, 19 women). Median age at cholecystectomy was 40, and 52 at liver transplantation. 66.7% of bile duct injuries were initially treated in a non-expert center. Median time between injury and liver transplantation was 3 years in case of an associated vascular injury (36.6% of injuries), against 11.7 years without vascular injury (p=0.006). More than a quarter of patients had to have an expert component to access liver transplantation. Mortality was 23.3%, mainly by haemorrhage. Conclusion: treatment of bile duct injury in a non-expert center and presence of an associated vascular injury are risk factors of liver transplantation. Transplantation may have to be considered before secondary biliary cirrhosis, which is highly deadly.
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Master Thesis
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Maxime Guieu. Transplantation hépatique pour plaie iatrogène des voies biliaires post-cholécystectomie : étude rétrospective multicentrique nationale française. Médecine humaine et pathologie. 2018. ⟨dumas-02071839⟩

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