Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Γεώργιος Σωτηρόπουλος, Αν. Καθηγητής, Ιατρικής Σχολή, ΕΚΠΑ (Επιβλέπων)
Γρηγόριος Κουράκλης, Καθηγητής,Ιατρικής Σχολή, ΕΚΠΑ
Κωνσταντίνος Κόντζογλου, Καθηγητής ,Ιατρικής Σχολή, ΕΚΠΑ
Νικόλαος Νικητέας, Καθηγητής , Ιατρικής Σχολή, ΕΚΠΑ
Δημήτριος Μαντάς, Αν. Καθηγητής , Ιατρικής Σχολή,ΕΚΠΑ
Δημήτριος Δημητρούλης, Αν. Καθηγητής, Ιατρικής Σχολή, ΕΚΠΑ
Στυλιανός Κύκαλος
Επ. Καθηγητής Ιατρικής Σχολή,ΕΚΠΑ
Original Title:
Μείζονες κακώσεις χοληφόρων κατά την διάρκεια λαπαροσκοπικής χολοκυστεκτομής που οδηγούν σε μεταμόσχευση ήπατος: μια συστηματική πολυκεντρική ανάλυση
Translated title:
Liver transplantation due to bile duct injuries during laparoscopic cholecystectomy
Summary:
Introduction: Liver transplantation (LT) has been used as a last resort solution in patients with end stage liver disease due to otherwise unmanageable bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy.
Methods: Data concerning patients who underwent LT after having suffered BDI during cholecystectomy from 8 high-volume LT centers were prospectively collected and retrospectively analyzed.
Results: Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT due to liver failure, most commonly as a result of secondary biliary cirrhosis (SBC). The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant30-day mortality and 10 deaths (29.4%) in total after LT. Overall survival following LT at 1-, 3-, 5- and 10-years was 82.4%, 76.5%, 73.5% and 70.6%, respectively.Based on our analysis, patients who underwent liver transplantation over a period of more than 2 years after the recognition of the injury will experience more postoperative complications. There was a higher probability for patients with concomitant vascular injury (HR: 10.69, p=0.039) to end up sooner to LT, as well as for those who had undergone laparoscopic cholecystectomy rather than an open one.
Conclusions: LT for selected patients with otherwise unmanageable BDI following cholecystectomy confers acceptable long-term outcomes.
Main subject category:
Health Sciences
Keywords:
Liver transplantation, Laparoscopic cholecystectomy, Bile duct injuries
Number of references:
144
