The long-term impact of post-cholecystectomy major bile duct injury on liver stiffness.

Introduction: Iatrogenic bile duct injuries (BDI) are a devastating complication. Long-term impact of corrective hepaticojejunostomy (HJ) for such injuries on post -surgery liver stiffness is lacking. Hence the aim of this study was to explore the extent of hepatic fibrosis in a cohort of patients with Strasberg E bile duct injuries who underwent HJ after a minimum follow-up of six months.

Methods: Out of 50 BDI presented over a period of 10-years, 19 patients with Strasberg type E, injuries that underwent HJ and completed a minimum 6-month follow-up [65.5 (7 -108)] period were selected. Data were prospectively collected on liver functions and liver stiffness was assessed using a Fibroscan. Their liver stiffness and degree of fibrosis was compared with (n = 38) age, gender and comorbidity matched controls.

Results: The median age was 47 (30-70) years, with 63% females. Primary HJ was performed in 84%, with a median time from injury to HJ of 7 (1-39) days. The total bilirubin was 16.5 (11.2) µmol/L, Alkaline Phosphatase was 102 (27.2) U/L, and Platelet count was 256 (77) x 10. Liver stiffness (median 6.4 kPa) did not significantly differ from controls (5.3 kPa). Fibrosis assessment revealed comparable distribution of F0 to F3 fibrosis between the study and control groups (F0/F1: 68.4% vs. 84.4%, F2: 10.5% vs. 9.4%). However, all three patients with right hepatic artery injury (p = 0.003) and three of five patients with bile duct stricture had F3/F4 fibrosis.

Conclusions: Major BDI repair demonstrates comparable liver fibrosis in the absence of artery injury and anastomotic strictures. Measuring liver fibrosis could be valuable in the presence of arterial injuries or anastomotic strictures.