ArticleWorld journal of gastrointestinal surgery2015
Iatrogenic bile duct injury with loss of confluence.
Article in World journal of gastrointestinal surgery, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 34 citations in OpenAlex.
- Successful Repair of a Strasberg E4 Bile Duct Injury With Double-Barreled Dual Hepaticojejunostomy: A Case Report.Cureus · 2025Article
- Anatomical Considerations for Biliary Interventions: Navigating Challenging Cases.Seminars in interventional radiology · 2025Review
- Article
- Iatrogenic Injury of Biliary Tree-Single-Centre Experience.International journal of environmental research and public health · 2022Article
- Postoperative liver function tests can predict anastomotic dysfunction after bile duct injury repair.Updates in surgery · 2022Article
- Partial segments 4/5 liver resection facilitates the repair of complicated bile duct injuries: a technical challenge and long-term outcomes.Updates in surgery · 2021Article
- Reliable reconstruction of the complex high-location bile duct injury: a novel hepaticojejunostomy.BMC surgery · 2019Article
- Article
- Acute Cholangitis After Bilioenteric Anastomosis for Bile Duct Injuries.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2017Article
- Portoenterostomy as a Salvage Procedure for Major Biliary Complications Following Hepaticojejunostomy.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2017Article
- Benign Biliary Strictures.Seminars in interventional radiology · 2016Review
Corrections and comments
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Authors and funding
7 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimTo describe our experience concerning the surgical treatment of Strasberg E-4 (Bismuth IV) bile duct injuries.
methodsIn an 18-year period, among 603 patients referred to our hospital for surgical treatment of complex bile duct injuries, 53 presented involvement of the hilar confluence classified as Strasberg E4 injuries. Imagenological studies, mainly magnetic resonance imaging showed a loss of confluence. The files of these patients were analyzed and general data were recorded, including type of operation and postoperative outcome with emphasis on postoperative cholangitis, liver function test and quality of life. The mean time of follow-up was of 55.9 ± 52.9 mo (median = 38.5, minimum = 2, maximum = 181.2). All other patients with Strasberg A, B, C, D, E1, E2, E3, or E5 biliary injuries were excluded from this study.
resultsPatients were divided in three groups: G1 (n = 21): Construction of neoconfluence + Roux-en-Y hepatojejunostomy. G2 (n = 26): Roux-en-Y portoenterostomy. G3 (n = 6): Double (right and left) Roux-en-Y hepatojejunostomy. Cholangitis was recorded in two patients in group 1, in 14 patients in group 2, and in one patient in group 3. All of them required transhepatic instrumentation of the anastomosis and six patients needed live transplantation.
conclusionLoss of confluence represents a surgical challenge. There are several treatment options at different stages. Roux-en-Y bilioenteric anastomosis (neoconfluence, double-barrel anastomosis, portoenterostomy) is the treatment of choice, and when it is technically possible, building of a neoconfluence has better outcomes. When liver cirrhosis is shown, liver transplantation is the best choice.
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