PubMed · 13667077
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B P COLCOCK. 1959. Problems in gallbladder surgery.. https://pubmed.ncbi.nlm.nih.gov/13667077/
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Previous studies showed that bile duct injury after cholecystectomy is associated with substantial morbidity and a negative effect on Quality of Life. In a recent study, patients with a bile duct injury after cholecystectomy exhibited a 3-fold increase in mortality during a follow-up period of nine years compared to patients without injury. This is the first study to demonstrate a negative impact of bile duct injury on survival. Repair by a less experienced surgeon leads to an 11% higher mortality during follow-up. Cholangiography should probably be performed routinely during cholecystectomy. A bile duct lesion should be suspected when the patient has not recovered within 48 hours. Endoscopic or percutaneous treatment of stenoses or leakage is usually successful, even after several weeks.
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Severe loss of bile ducts is a hallmark of chronic liver rejection. We hypothesize that loss of the finest branches of the biliary tree, including the intralobular segments, contributes to an impaired regenerative response of bile ducts in chronic rejection. The number and proliferative response of bile ducts, intraportal ductules, and extraportal biliary cells were studied in graft biopsies of 12 chronic-rejection patients. Twenty-two long-term-surviving patients who experienced acute rejection without chronic rejection served as controls. Reperfusion, 1-week, 1-month, and 1-year biopsies were studied. Monochlonal antibody Ki67 was applied to assess proliferation, and cytokeratin 7 antibody to identify bile ducts, intraportal ductules, and extraportal biliary cells. Progressive loss of bile ducts, intraportal ductules, and extraportal biliary cells was observed in the chronic-rejection group. In controls, all of these structures remained well preserved. Additionally, a significant increase of intraportal ductules was present at 1 week in controls, which was not the case in the chronic-rejection group. Proliferative activity of intraportal ductules and extraportal biliary cells was significantly increased at 1 week in controls. This proliferative activity was higher in the intraportal ductules of controls, compared with the chronic-rejection group. After 1 week, proliferative activity was virtually absent in both groups. In conclusion, our results showed that a deficient proliferative response of the finer branches of the biliary tree, including its intralobular segments, might contribute to bile-duct loss in chronic rejection. This finding supports the postulation that these structures represent a regenerative compartment of the biliary unit in the liver.