Acute XXXX . The need for a high repair.

@entity1 @entity63 @entity1157 @entity254 @entity850 @entity130
BACKGROUND: An immediate repair is considered optimal in acute biliary duct injuries; however, it may prove to be a challenge, because such repairs are usually performed on small ducts whose viability cannot always be determined. METHODS: We performed a retrospective review of the charts of @entity1 with acute @entity1157 who underwent repair at a tertiary care academic university hospital. A total of 204 @entity1 with acute @entity1157 were seen between 1989 and 2002. Of these, 30 were repaired within minutes to hours after the injury. These @entity1 were divided into two groups. Group I @entity1 had a Roux-en-Y hepatojejunostomy below the hepatic junction; Group II @entity1 had a Roux-en-Y hepatojejunostomy at the junction level. We then performed a long-term evaluation of @entity254 function in these @entity1 , using clinical, radiological, and laboratory. RESULTS: Twenty-eight injuries were secondary to a laparoscopy; the other two resulted from open cholecystectomies. All of the @entity1 suffered @entity130 with complete section of the duct and substance loss (Strasberg E). There were 12 @entity1 in group I and 18 in group II. Three cases in group I (25%) and one in group II (5%) developed @entity254 dysfunction. Mean follow-up was 56 months (range, 12-80) in group I and 52 months (range, 10-76) in group II. Two cases in group I (16%) and none in group II (0) required reoperation (p < 0.05). CONCLUSIONS: In the acute setting, complex lesions should be treated with a high bilioenteric @entity254 (at the junction level) in the first attempt at repair. Lower-level anastomoses are associated with a higher dysfunction rate and the need for radiological manipulation and reoperation. Also, @entity850 of the @entity254 secondary to undetected duct @entity63 in the acute repair is more frequent in low bilioenteric anastomoses.
