Bile duct reconstruction after iatrogenic injury in the elderly

Bile duct injuries occur with a frequency of 1 to 5 per 1000 cases as a result of an increase in the number of procedures performed. Elderly patients have more severe lithiasis-related diseases than the younger population. This fact increases the likelihood of conversion from laparoscopic to open surgery, and the probability of injury. We report the results of bile duct reconstruction after injury in these patients. Setting: A tertiary care academic university hospital. Methods: The files of patients over 65 years of age who had biliary tract reconstruction after iatrogenic injury were retrospectively reviewed. Post operative results, quality of life and failures from the repair were analyzed. Results: 20 patients over the age of 65 were referred for biliary tract reconstructive surgery over a ten year period. Mean age was 71 (65 – 83). Nineteen cases were referred from other hospitals. Fourteen cases (60%) had comorbidities (type 2 diabetes mellitus, systemic hypertension). All patients were treated by means of Roux en Y hepatojejunostomy. No operative morbility was recorded and only one major complication (abdominal collection) was found. Two long term mortalities unrelated to surgery were found. Treatment success (as defined by the Johns Hopkins criteria) was obtained in 17 cases (85%) and only one patient (5%) required reoperation two years after the initial attempt. Conclusions: Elderly patients that survive biliary injury and are reconstructed have long-term results comparable to the younger population; Roux en Y hepatojejunostomy offers the best surgical choice.