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Effect of surgical biliary drainage on liver stiffness in benign biliary stricture: a Fibroscan® evaluation
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Electronic Poster Abstracts
management of BBS. Pre-operative factors, intraoperative parameters, postoperative morbidity and follow-up details were noted. Outcomes were graded according to McDonald classification. Results: Six hundred forty eight patients of BBS were included. Eleven patients underwent HR (1.69%). Ten patients were of proximal BBS (type IV and V) while 1 patients was type III BBS. Three patients had stricture of previous repair (2 patients of hepaticojejunostomy and 1 of left hepaticoportoenterostomy). Associated vascular injury was present in 36.3% (4/11). Laparoscopic cholecystectomy (LC) was the primary surgery in 72.7% (8/11) (p < 0.001) patients. Median time from cholecystectomy to HR was 545 (226e1566) days. Proximal BBS (type IV and V, p < 0.001) and Atrophy-hypertrophy complex (AHC) (63.6%, 7/11patients) (p = 0.004, OR = 15.4, CI: 2.94e80.99) were predictive factors for HR in our study. Failed previous repair was also associated with HR (27%). Postoperative morbidity was 81.8% (9/11). Perioperative mortality occurred in 2 patients (18%). One patient expired in follow up after readmission for cholangitic abscess one year after surgery. Outcomes of HR with median follow up of 18 months were good with success rate of 63.6%. Conclusions: Hepatic resection has distinct role in select cases of complex BBS (type IV and V) with AHC with satisfactory long term results. AHC is a strong predictor for need for HR in BBS.
EP03F-002 EFFECT OF SURGICAL BILIARY DRAINAGE ON LIVER STIFFNESS IN BENIGN BILIARY STRICTURE: A FIBROSCANÒ EVALUATION R. Saxena1, R. K. Singh2, N. Kumari3 and T. S. Negi4 1 Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, 2Surgical Gastroenterology, SGPGIMS, 3Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, and 4Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, India Introduction: Post-cholecystectomy benign biliary stricture (BBS) can lead to secondary biliary cirrhosis (SBC). Portal hypertension develops in 15e20% of patients with BBS. Patients and methods: A prospective study on patients of BBS between 1e2012 and 6e2014, to study the change in liver stiffness (E-value) as measured by FibroscanÒ in patients with BBS before and 3 months after surgical repair. An intraoperative liver biopsy was correlated with E-value. All patients underwent preoperative routine investigations (hematological, biochemical), viral evaluation, abdominal duplex sonography, magnetic resonance cholangiopancreatography and an upper gastrointestinal endoscopy. Patients with an external biliary fistula, cirrhosis, hepatitis virus positivity and history of chronic alcohol ingestion were excluded. All patients underwent a Roux-en-Y hepaticojejunostomy (HJ).
Results: 20 Patients with BBS (mean age 40.6 years, 13 female) were studied. The BBS (Bismuth classification) was type I (1), type II (7), type III (7), type IV (1) and type V (4). 5 patients (25%) had esophageal varices on UGIE. Liver biopsy revealed no fibrosis in 6, portal/periportal fibrosis in 9, and septal fibrosis in 5 patients. Preoperative liver stiffness was normal (E-value <7.0 kPa) in 5, mild to moderate fibrosis (E-value 7e 17.3 kPa) in 7, and cirrhotic (E-value >17.3 kPa) in 8 patients. At 3 months post HJ, liver stiffness was normal in 13 patients, mild to moderate fibrosis in 6 patients, and cirrhotic in 1 patient. Conclusions: Liver stiffness improved in 9/15 (60%) patients after HJ. E-value did not directly correlate with portal hypertension, or liver fibrosis on biopsy.
EP03F-003 CONCOMITANT VASCULAR INJURIES ASSOCIATED WITH POSTCHOLECYSTECTOMY IATROGENIC BILE DUCT INJURIES: INCIDENCE AND MANAGEMENT IN A HIGH VOLUME CENTER O. Hegazy, H. Abdel-Meged, H. E. Soliman, S. Saleh, T. Yassein, E. Gad, E. Ayob, A. Sallam, K. Abuella, T. Ibrahim, M. Abu-Shady and G. Said HPB Surgery, National Liver Institute, Menoufia University, Egypt Aims: Concomitant vascular injury with post cholecystectomy bile duct injury is possible. It is considered as an increasing finding during repair. Thus, assessment of those injuries is crucial for defining the optimal surgical management. Methods: One hundred and thirty patients were managed surgically for post-cholecystectomy bile duct injury between January 2010 and December 2014 in the Department of HPB Surgery, National Liver Institute, Menoufia University in Egypt. Patients records were revised including preoperative, intraoperative and postoperative data. Follow up visits were also revised. Vascular injury was identified intra-operatively at the beginning of the study while, later, all patients were carried out Computed Topographic hepatic angiography. Results: Twenty eight patients had concomitant vascular injury. Majority were females (75%) with mean age 35 years (range, 30e50 years). Most of the injuries were post open cholecystectomy (71%). All the patients had right hepatic artery injury while seven had added right portal vein injury. Fifteen patients had right hepatectomy and left hepatico-jejunostomy (53%). Three patients died (11%) due to sepsis and multi-organ failure. The remaining patients had conventional hepaticojejunostomy. Conclusions: Assessment of vascular injury is an important part in the management of patients with bile duct injuries. Isolated arterial or combined portal injuries may lead to hepatectomy while mortality occurred due to cholangitic abscesses, severe cholangitis with subsequent sepsis.
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
management of BBS. Pre-operative factors, intraoperative parameters, postoperative morbidity and follow-up details were noted. Outcomes were graded according to McDonald classification. Results: Six hundred forty eight patients of BBS were included. Eleven patients underwent HR (1.69%). Ten patients were of proximal BBS (type IV and V) while 1 patients was type III BBS. Three patients had stricture of previous repair (2 patients of hepaticojejunostomy and 1 of left hepaticoportoenterostomy). Associated vascular injury was present in 36.3% (4/11). Laparoscopic cholecystectomy (LC) was the primary surgery in 72.7% (8/11) (p < 0.001) patients. Median time from cholecystectomy to HR was 545 (226e1566) days. Proximal BBS (type IV and V, p < 0.001) and Atrophy-hypertrophy complex (AHC) (63.6%, 7/11patients) (p = 0.004, OR = 15.4, CI: 2.94e80.99) were predictive factors for HR in our study. Failed previous repair was also associated with HR (27%). Postoperative morbidity was 81.8% (9/11). Perioperative mortality occurred in 2 patients (18%). One patient expired in follow up after readmission for cholangitic abscess one year after surgery. Outcomes of HR with median follow up of 18 months were good with success rate of 63.6%. Conclusions: Hepatic resection has distinct role in select cases of complex BBS (type IV and V) with AHC with satisfactory long term results. AHC is a strong predictor for need for HR in BBS.
EP03F-002 EFFECT OF SURGICAL BILIARY DRAINAGE ON LIVER STIFFNESS IN BENIGN BILIARY STRICTURE: A FIBROSCANÒ EVALUATION R. Saxena1, R. K. Singh2, N. Kumari3 and T. S. Negi4 1 Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, 2Surgical Gastroenterology, SGPGIMS, 3Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, and 4Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, India Introduction: Post-cholecystectomy benign biliary stricture (BBS) can lead to secondary biliary cirrhosis (SBC). Portal hypertension develops in 15e20% of patients with BBS. Patients and methods: A prospective study on patients of BBS between 1e2012 and 6e2014, to study the change in liver stiffness (E-value) as measured by FibroscanÒ in patients with BBS before and 3 months after surgical repair. An intraoperative liver biopsy was correlated with E-value. All patients underwent preoperative routine investigations (hematological, biochemical), viral evaluation, abdominal duplex sonography, magnetic resonance cholangiopancreatography and an upper gastrointestinal endoscopy. Patients with an external biliary fistula, cirrhosis, hepatitis virus positivity and history of chronic alcohol ingestion were excluded. All patients underwent a Roux-en-Y hepaticojejunostomy (HJ).
Results: 20 Patients with BBS (mean age 40.6 years, 13 female) were studied. The BBS (Bismuth classification) was type I (1), type II (7), type III (7), type IV (1) and type V (4). 5 patients (25%) had esophageal varices on UGIE. Liver biopsy revealed no fibrosis in 6, portal/periportal fibrosis in 9, and septal fibrosis in 5 patients. Preoperative liver stiffness was normal (E-value <7.0 kPa) in 5, mild to moderate fibrosis (E-value 7e 17.3 kPa) in 7, and cirrhotic (E-value >17.3 kPa) in 8 patients. At 3 months post HJ, liver stiffness was normal in 13 patients, mild to moderate fibrosis in 6 patients, and cirrhotic in 1 patient. Conclusions: Liver stiffness improved in 9/15 (60%) patients after HJ. E-value did not directly correlate with portal hypertension, or liver fibrosis on biopsy.
EP03F-003 CONCOMITANT VASCULAR INJURIES ASSOCIATED WITH POSTCHOLECYSTECTOMY IATROGENIC BILE DUCT INJURIES: INCIDENCE AND MANAGEMENT IN A HIGH VOLUME CENTER O. Hegazy, H. Abdel-Meged, H. E. Soliman, S. Saleh, T. Yassein, E. Gad, E. Ayob, A. Sallam, K. Abuella, T. Ibrahim, M. Abu-Shady and G. Said HPB Surgery, National Liver Institute, Menoufia University, Egypt Aims: Concomitant vascular injury with post cholecystectomy bile duct injury is possible. It is considered as an increasing finding during repair. Thus, assessment of those injuries is crucial for defining the optimal surgical management. Methods: One hundred and thirty patients were managed surgically for post-cholecystectomy bile duct injury between January 2010 and December 2014 in the Department of HPB Surgery, National Liver Institute, Menoufia University in Egypt. Patients records were revised including preoperative, intraoperative and postoperative data. Follow up visits were also revised. Vascular injury was identified intra-operatively at the beginning of the study while, later, all patients were carried out Computed Topographic hepatic angiography. Results: Twenty eight patients had concomitant vascular injury. Majority were females (75%) with mean age 35 years (range, 30e50 years). Most of the injuries were post open cholecystectomy (71%). All the patients had right hepatic artery injury while seven had added right portal vein injury. Fifteen patients had right hepatectomy and left hepatico-jejunostomy (53%). Three patients died (11%) due to sepsis and multi-organ failure. The remaining patients had conventional hepaticojejunostomy. Conclusions: Assessment of vascular injury is an important part in the management of patients with bile duct injuries. Isolated arterial or combined portal injuries may lead to hepatectomy while mortality occurred due to cholangitic abscesses, severe cholangitis with subsequent sepsis.
HPB 2016, 18 (S1), e385ee601