Factors influencing the occurrence of biliary stricture above the confluence in major bile ducts injuries: Analysis of a case series

BACKGROUND: bile duct injury is a complication that occurs mainly after cholecystectomy. Outcomes of biliary repair surgery are worse when the stricture level is above the biliary confluence. METHOD: A single centred retrospective study was carried out on patients operated in our department for biliary stricture after a major bile duct injury over the period from January 2010 to May 2018. Only patients operated for biliary stricture were included. This study aimed to determine the independent factors influencing the occurrence of a stricture above de biliary confluence. Univariate and multivariate binary regression was used for data analysis. RESULTS: Fifty-three patients were included, they were 43 women and 10 men, sex-ratio was 0.23. Thirty-one patients had Grade E3–E4-E5 stricture (58,5%), and patients who had a failure of a previous repair surgery accounted for 36% (n = 19) of our patients. After univariate and multivariate analysis, only laparoscopic cholecystectomy (OR = 7.58, CI = [1.47–38, 91], P = 0.015) and failure of anterior biliary repair surgery (OR = 7, 12, CI = [1.29–39.42], P = 0.025) were independent factors associated with more frequent occurrence of biliary strictures above the confluence. CONCLUSION: Failure of biliary repair surgery makes the pre-existing biliary stricture progress and compromises subsequent surgery's outcomes. It is important to refer all cases of bile duct injury to specialized centers to increase the chances of success of the first biliary repair surgery.