History of the Interventional Pancreaticobiliary Endoscopy.

With the introduction of endoscopic retrograde cholangiopancreatography and linear endoscopic ultrasound, interventional pancreaticobiliary (PB) endoscopy has had an enormous impact in the management of pancreatic and biliary diseases. Continuous efforts to improve various devices and techniques have revolutionized these treatment modalities as viable alternatives to surgery. In recent years, trends toward combining endoscopic techniques with other modalities, such as laparoscopic and radiological interventions, for complex PB diseases have emerged using a multidisciplinary approach. Ongoing research and clinical experience will lead to refinements in interventional PB endoscopic techniques and subsequently improve outcomes and reduce complication rates.

Long-term disease control by endobiliary radiofrequency ablation in localized extrahepatic cholangiocarcinoma: a first case report.

An 84-year-old woman with cerebrovascular disease, dementia, and chronic kidney disease developed jaundice because of localized extrahepatic cholangiocarcinoma (eCCA) at the lower bile duct. Aggressive treatment, including surgery and chemotherapy, was difficult because of the underlying disease; therefore, only metal stent placement with endobiliary radiofrequency ablation (RFA) was performed. Subsequently, six additional RFA sessions were performed 12, 16, 24, 27, 33, and 36 months after the initial RFA using the same settings as the first RFA session. All these procedures were performed for tumor ingrowth. Computed tomography performed 42 months after the initial procedure revealed no stent with stricture resolution and no other metastatic lesion. Thereafter, no recurrence or adverse events have been observed with persisting stent-free status until the reporting of this study (72 months after the initial procedure). This is the first report of a stent-free status and long-term survival in a patient with localized eCCA that was achieved using only endobiliary RFA without any other anti-tumor treatment. Although several problems and issues associated with endobiliary RFA remain unelucidated, it may be a useful therapeutic option for early and localized eCCA in poor surgical candidates.

A comparative study on the application of different endoscopic diagnostic methods in the differential diagnosis of benign and malignant bile duct strictures.

Objective: To compare the diagnostic value of cytobrush, ERCP-guided biopsy, SpyGlass direct visual impression and SpyGlass-guided biospy (SpyBite) in the differential diagnosis of benign and malignant bile duct strictures. Methods: The data of 1,008 patients who were clinically diagnosed with indeterminate biliary strictures and underwent ERCP-guided biopsy, cytobrush, SpyGlass direct visual impression or SpyBite at the First Affiliated Hospital of Nanchang University between January 2010 and December 2019 were collected and analyzed retrospectively. The final diagnose was determined by surgical pathological specimen or follow-up (Malignant stricture can be identified if the stricture showed malignant progression during one year of follow-up). The differential diagnostic value of the above endoscopic diagnostic methods was evaluated by means of sensitivity, specificity, accuracy, positive predictive value, negative predictive value, etc. and safety was evaluated by the incidence rate of adverse events. Results: In terms of sensitivity, standard biopsy group (48.6%) and SpyBite group (61.5%) were significantly higher than cytobrush group (32.0%), and visual impression group (100%) was significantly higher than any other group. As far as specificity was concerned, cytobrush group (99.0%), standard biopsy group (99.3%) and the SpyBite group (100%) were significantly higher than visual impression (55.6%), but there was no statistical difference among the three groups above. As far as accuracy was concerned, standard biopsy group (65.3%), and SpyBite group (80.0%) were significantly higher than cytobrush group (44.4%), and SpyBite group (80.0%) was significantly higher than visual impression group (54.8%). In terms of safety, visual impression group and SpyBite group were significantly higher than cytobrush group and standard biopsy group in post-ERCP cholangitis. Conclusion: SpyBite combined with SpyGlass-guided visual impression was better for differential diagnosis of benign and malignant bile duct strictures in terms of sensitivity and accuracy compared with conventional endoscopic diagnostic methods such as cytobrush and standard biopsy. Furthmore, the incidence rates of adverse events after SpyGlass examination was similar to those after conventional endoscopic diagnostic methods except for higher cholangitis, which could be controlled by antibiotics and might be avoided by adequate biliary drainage.

Right posterior bile duct stricture after laparoscopic anterior sectionectomy with long right bile duct: A case report.

Right anterior liver sectionectomy (RAS) is a complicated procedure with high incidences of postoperative complications. We report a case of right posterior bile duct (RPBD) stricture after laparoscopic RAS with discussion of the anatomical aspects. A 69-year-old Japanese man had solitary colorectal liver metastasis. A tumor was located near the root of the right anterior Glissonean pedicle. On postoperative day 6, he had cholangitis and imaging studies showed RPBD stricture. Symptoms disappeared following a course of antibiotics and the patient was discharged on postoperative day 21. The RBPD anatomy type of this patient was a supra-portal pattern with a long (18 mm) right biliary duct, which would be close to the right anterior Glissonean bifurcation. A stapling device might have caused its deformation and resulted in its stricture. As the RPBD has variant anatomy, we had to notice that there may be hazardous types for postoperative RPBD stricture.

Sarcoidosis of the Bile Duct.

Sarcoidosis is an inflammatory disease that affects multiple organs. The lungs are the most commonly involved organs. Although a large proportion of patients with sarcoidosis have liver involvement, bile duct involvement is rare. Here, we present a case of a 56-year-old African American patient presented with painless jaundice because of extrahepatic bile duct sarcoidosis. Our diagnostic approach using endoscopic cholangioscopy with targeted biopsies confirmed the diagnosis. Multiple bile duct stent exchanges were performed to manage the bile duct stricture in addition to medical therapy.

Post cholecystectomy benign biliary stricture-isolated hepatic duct stricture: a proposed modification of the BISMUTH classification.

BACKGROUND: Post-cholecystectomy, benign biliary strictures are challenging for both patients and surgeons. Bismuth classified benign biliary strictures into 5 types. This study aimed to review these isolated hepatic duct strictures which were not included in Bismuth classification. METHODS: The case records of all patients who presented with post-cholecystectomy benign biliary strictures between January 2005 and December 2020 at our centre were reviewed. Data regarding demography, type of stricture, and treatment strategy were entered into the standard proforma. RESULTS: There were 242 patients [type I-3.7%, type II-41.7%, type III-38.0%, type IV-6.6%, and type V-7.8%]. Five (2.1%) patients did not fit the Bismuth classification and were the focus of this study. In each of these patients, an isolated hepatic duct stricture (first-or second-order hepatic duct) was present, with no involvement of the common hepatic duct or hilar confluence. CONCLUSIONS: The addition of isolated hepatic duct stricture [type VI] to the Bismuth classification will enhance the original classification, help in reporting and management of this sub-set of patients.

Endoscopic ultrasound-guided hepaticogastrostomy in a patient with post esophagectomy and gastric tube reconstruction: a case report.

A 54-year-old woman with a history of esophageal adenocarcinoma suffered from obstructive jaundice after completing esophagectomy with gastric tube reconstruction and adjuvant concurrent chemoradiotherapy 1 year. An abdominal computed tomography showed that the common bile duct was compressed by metastatic lymphadenopathy. She received endoscopic retrograde cholangiopancreatography first but it was failed in cannulation. Then, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed with a partially covered metallic stent placed from the stomach to the left intrahepatic duct. Though aspiration pneumonia occurred after the procedure, she recovered on the next day. She resumed oral intake since the third day without fever or abdominal pain and she was discharged on the seventh day after the procedure. This is the second case report of placing a partially covered metallic stent through EUS-HGS in a patient with post esophagectomy and gastric tube reconstruction and it can be an alternative treatment.

Hiatal Hernia with Prolapse of the Pancreas Causing Bile Duct Stricture and Liver Function Disorders: A Case Report and Literature Review.

Hiatal hernia is a common condition in elderly patients, but the additional presence of prolapse of the pancreas is extremely rare. We herein report an 89-year-old woman who presented with liver function disorders and abdominal pain. Her laboratory tests revealed cholestasis, and imaging examinations showed stenosis of the common bile duct pulled toward the hernia sac. She was diagnosed with a common bile duct stricture due to pancreatic herniation and underwent laparoscopic surgery. Our review of the literature identified three types of pancreatic herniations: asymptomatic, bile duct complication, and acute pancreatitis. Pancreatic head herniation tends to induce bile duct complications.

Effect of percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy in the treatment of benign hepatic bile duct strictures / 中华肝胆外科杂志

Objective:To investigate the therapeutic effect of percutaneous transhepatic one-step biliary fistulation (PTOBF) combined with rigid choledochoscopy in the treatment of benign hepatic bile duct strictures.Methods:The clinical data of 46 patients with hepatic ductal stenosis and stones undergoing PTOBF combined with rigid choledochoscopy at the First Hospital of Guangzhou Medical University between September 2016 and September 2022 were retrospectively analyzed, including 20 males and 26 females, aged (48.5±17.6) years. The location of stones and strictures, stone retrieval rate, postoperative complications, stricture release rate, stone recurrence rate, and reoperation rate were analyzed to access the safety and effectiveness of this procedure.Results:A total of 58 sites of stenoses were found in 46 patients, and PTOBF lithotripsy combined with rigid choledochoscopy were performed for 77 times. The early postoperative complication rate was 19.6% (9/46), and the stenosis release rate was 93.5% (43/46). The mean follow-up time was (28.1±19.6) months, the complete stone retrieval rate was 91.3% (42/46), the stone recurrence rate was 19.6% (9/46), the reoperation rate was 8.7% (4/46), and the long-term postoperative complication rate was 6.5% (3/46).Conclusion:PTOBF combined with rigid choledochoscopic stenoplasty for benign hepatic duct strictures is a safe and feasible procedure to reduce the stone recurrence and long-term postoperative complications.

Significance of KRAS mutation testing in biliary brushing cytology specimens: A 10-year retrospective review.

BACKGROUND: Biliary strictures can be caused by benign and malignant conditions. A biliary duct brushing diagnosis can be challenging because of low cellularity and overlapping morphology among different entities, leading to a variable reported sensitivity. This study aimed to assess the value of KRAS mutation testing in adding cytological diagnosis of biliary duct brushings. METHODS: With institutional review board approval, biliary duct brushing cytology specimens were collected from 269 patients with extrahepatic biliary stenosis between August 2011 and July 2021. The results of cytology and KRAS mutational analyses were evaluated in view of corresponding cytology examination and histopathological/clinical follow-up. RESULTS: KRAS mutations were identified in 50 of 269 biliary stricture brushing cases (19%). Among the cases with available follow-up, 72% (34 of 47) of biliary brushings had confirmed malignancy when there were KRAS mutations. The overall specificity and sensitivity of KRAS mutation testing was 92% and 36%, respectively. KRAS mutation was significantly more enriched in pancreatic duct adenocarcinoma than in cholangiocarcinoma (66% vs 5%, P < .001). The absolute risk of malignancy was 3%, 28%, and 71%, respectively, in negative, atypical, and suspicious cytological diagnostic categories and the risks increased to 14%, 68%, and 95% in corresponding categories with KRAS mutation. CONCLUSIONS: Our results suggested that KRAS mutational analysis can be considered supplementary to cytology diagnosis of biliary duct brushing for patients with extrahepatic biliary stenosis in clinical practice.

Minimally Invasive Management of Bile Leak Following Displaced Percutaneous Transhepatic Biliary Stent.

Biliary endoprosthesis plays a crucial role in the management of patients with obstructive jaundice. However, a biliary leak is a life-threatening complication of this procedure. A 52-year-old otherwise healthy man presented with obstructive jaundice and was found to have a stricture at the confluence of the right and left hepatic ducts, which was managed with the placement of an uncovered self-expanding metallic stent. He rapidly deteriorated, and an active bile leak in the peritoneum due to stent displacement through the liver was discovered, which was successfully managed in a minimally invasive manner via laparoscopy. The extrahepatic part of the metallic stent was cut and removed, the peritoneum was washed out, and multiple drains were placed. The patient improved clinically, and his biochemical parameters returned to normal.

Short- and intermediate-term evaluation of the initial definitive operation for perforated choledochal cysts compared to two-stage management.

BACKGROUND: Recently, single definitive hepaticojejunostomy has been proposed to replace two-stage procedures, including initial urgent biliary drainage and final biliary reconstruction, with a reduced hospitalization time and corresponding overall hospitalization cost. We aimed to investigate the safety and efficacy of the initial definitive operation compared with the two-stage approach. METHODS: The medical records of patients with perforated CDCs managed between 2010 and 2017 were retrospectively reviewed. The qualified samples were divided according to a single definitive operation or two-stage approach. We conducted a comparison of the clinical characteristics, including surgical parameters, length of stay, and short- and intermediate-term complications. RESULTS: A total of 117 patients with perforated CDCs were reviewed, with 48 cases of single-stage management and 69 cases of two-stage management. No differences in the baseline characteristics between the two groups were found, such as age, sex distribution, ultrasound presentation, or laboratory findings. The initial definitive operation was associated with a lower total duration of drainage, including abdominal drainage and biliary drainage (p < 0.001), and rate of unplanned readmission (OR, 0.056; 95% CI 0.007-0.435; p < 0.001) than those who underwent two-stage management. Furthermore, the initial definitive operation significantly reduced the postoperative hospital stay (p < 0.001), and the overall hospitalization cost was accordingly reduced compared with two-stage management (p < 0.001). CONCLUSIONS: The initial single definitive operation was safe and effective for most of the patients with perforated CDCs when expertise was available. Therefore, a single definitive operation should be considered the treatment of choice for perforated CDCs.

Dynamic Intraductal Endoscopic Visualization of Right Hepatic Artery Pulsation Underlying Minor Vascular Impression of the Proximal Bile Duct.

Right hepatic artery (RHA) syndrome is a well-recognized, though an uncommon cause of benign bile duct stricture, potentially simulating malignancy. Albeit the latter was not the case in this unique clinical report after cholangitis resolution and clearance of biliary sludge and debris, high-quality direct cholangioscopy (DC) illustration of the RHA overriding the proximal common bile duct with well visible arterial pulsation has not yet been reported before. Beyond its potential visual informativeness, this uncommon cholangioscopic documentation may provide key didactic advances in terms of intraductal visualization of the anatomy of the biliary tree. How to cite this article: Zimmer V. Dynamic Intraductal Endoscopic Visualization of Right Hepatic Artery Pulsation Underlying Minor Vascular Impression of the Proximal Bile Duct. Euroasian J Hepato-Gastroenterol 2021;11(1):41-42.

A case of juvenile eosinophilic cholangitis: Rapid peripheral blood hypereosinophilia after admission leading to diagnosis.

A 15-year-old boy was referred to our hospital with elevated hepatobiliary enzyme levels and jaundice. Magnetic resonance cholangiopancreatography performed at the previous medical facility revealed a stricture of the intrahepatic and extrahepatic bile duct. Computed tomography showed dilatation and wall thickness of the intrahepatic bile ducts. Primary sclerosing cholangitis or cholangiocarcinoma was suspected. Endoscopic retrograde cholangiopancreatography (ERCP) showed stricture in the intrahepatic and extrahepatic bile duct. On admission, the eosinophil count in the peripheral blood was normal; however, rapid hypereosinophilia in the peripheral blood was observed after admission, leading us to suspect eosinophilic cholangitis (EC). A bile duct biopsy showed inflammatory cells and eosinophil infiltration during a second ERCP. The patient was diagnosed with EC based on histopathology.

Hepatolithiasis: clinical series, review and current management strategy.

OBJECTIVES: Hepatolithiasis (HL) continues to be a problem due to its local and systemic complications, insufficiency in treatment modalities and high risk of recurrence. There are various surgical options available, ranging from endoscopic interventions to a small segment resection and ultimately to transplantation. In this article, patients with the diagnosis of HL and our treatment strategies were evaluated in the light of literature. MATERIAL AND METHODS: The patients diagnosed with HL in our clinic between 2014-2019 were evaluated retrospectively by examining the patient files. Demographic characteristics of the patients, causes of the disease, complications and treatment options were evaluated. RESULTS: 17 patients were included into the study. Mean age of the patients was 64.3 years (range 32-89 years). Seven patients had previous cholecystectomies. Stenosis was found to be developed in hepaticojejunostomy (HJ) site in three patients (two had HJ due to bile duct injury and one had HJ following the Whipple procedure), and in hepaticoduodenostomy site in one patient who had the history of biliary tract injury during cholecystectomy. Two patients with HL without previous cholecystectomies had no gallbladder stones. Nine patients underwent surgery. Left hepatectomy was performed in two patients and lateral sector resection was performed in 2 patients. Two patients with anastomotic stenosis underwent HJ revision and two patients with anastomotic stenosis and one patient with stent ingrowth underwent bifurcation resection and neo-hepaticojejunostomy. Eight patients were followed-up nonoperatively with medical and endoscopic approaches. CONCLUSION: Hepatolithiasis is a serious condition that needs to be treated with a multimodal approach. Stenting and anastomotic stenosis facilitate the development of hepatolithiasis and increase the risk of its occurrence. In particular, by performing functional hepaticojejunostomy, the development of this complication will be decreased.

Intraductal placement of non-flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long-term results of prospective multicenter trial.

BACKGROUND AND AIM: Fully covered self-expandable metallic stent (FCSEMS) may be an effective modality for managing anastomotic biliary stricture (ABS) after liver transplantation. However, stent migration and stent-induced ductal injury are the main limitations. The objective of this study was to evaluate the usefulness of an unflared, intraductal FCSEMS that was designed to minimize migration and ductal injury for refractory ABS after living donor liver transplantation (LDLT). METHODS: A total of 32 consecutive patients with symptomatic ABS after LDLT unresolved by plastic stents with or without balloon dilation at four tertiary medical centers were prospectively enrolled. A short (3 or 5 cm) FCSEMS having long lasso (10 cm) used in this study had unflared convex ends to minimize tissue hyperplasia and smaller center portion to prevent migration. The FCSEMS was placed above the papilla and removed at 3-4 months after stenting. RESULTS: Technical and clinical success rates of intraductal placement with FCSEMS were 100% (32/32) and 81.2% (26/32), respectively. Early stent migration was observed in five (15.6%) patients. However, three patients with early stent migration had stricture resolution without needing additional intervention. Intended stent removal was successful in 27 (100%) patients (median, 101 days; range, 23-118 days). No stent-induced ductal change was observed in all patients. Stricture recurrence was observed in 11.5% (3/26) of patients during 639 days of median duration of follow-up (range, 366-2079 days). CONCLUSIONS: Intraductal placement of an unflared short FCSEMS may be a promising option for refractory ABS after LDLT with minimal stent-induced ductal injury and stent migration.

A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy.

BACKGROUND: In situ cholangiocarcinoma is difficult to detect by imaging studies. Thus, cholangiocarcinoma is rarely resected with a preoperative definitive diagnosis, especially nonpapillary flat type in situ carcinoma, which is extremely rare. CASE PRESENTATION: A 70-year old man was diagnosed with gallbladder cancer and received open cholecystectomy with lymphadenectomy at a local hospital. Histologically, the tumor was localized in the mucosal layer, and no lymph node metastases were found. Three months later, hilar bile duct stricture due to delayed bile duct ischemia was found. Then, biliary drainage was performed with endoscopic biliary stenting. Three months later, the patient experienced cholangitis with septic shock, and percutaneous transhepatic biliary drainage (PTBD) into the left intrahepatic bile duct was performed. Unexpectedly, the aspiration bile cytology of the PTBD catheter showed malignant cells, and the patient was referred to our clinic for possible surgical treatment. According to additional studies, the hilar bile duct stricture was 3 cm in length. None of the imaging studies detected malignant cells in the bile duct around the hilar stricture. The left portal vein was obstructed due to inadvertent puncture of the PTBD. No findings indicated cholangiocarcinoma. We performed left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. The postoperative course was uneventful. In the final pathology, flat type in situ carcinoma was found at the confluence of the right and left hepatic ducts, which was distant from the biliary stricture. CONCLUSIONS: When a tumor is undetectable but cytology is positive, in situ cholangiocarcinoma may exist; thus, surgery should be carefully considered.

Robotic choledochoduodenostomy for benign distal common bile duct stricture: how we do it.

Benign bile duct stricture poses a significant challenge for gastroenterologists and general surgeons due to the inherent nature of the disease, difficulty in sustaining long-term solutions and fear of pitfalls in performing biliary tract operations. Operative management with an open biliary bypass is mainly reserved for patients who have failed multiple attempts of endoscopic and percutaneous treatments. However, recent advances in minimally invasive technology, notably in the form of the robotics, have provided a new approach to tackling biliary disease. In this technical report, we describe our standardized method of robotic choledochoduodenostomy in a 59-year-old woman with history of Roux-en-Y gastric bypass who presents with benign distal common bile duct stricture following failure of non-operative management. Key steps in this approach involved adequate duodenal Kocherization, robotic portal dissection and creation of a side-to-side choledochoduodenal anastomosis. The operative time was 200 min with no intraoperative complications and estimated blood loss was less than 50 mL. No abdominal drains were placed. The patient was discharged home on postoperative day 1 tolerating regular diet and able to resume her usual activities within 1 week of her operation. A video is attached to this report.

Effects of definitive repair surgery on health-related quality of life in patients with bile duct injury after laparoscopic cholecystectomy / 中华消化外科杂志

Objective To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC).Methods The retrospective case-control study was conducted.The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected.There were 82 males and 99 females of 181 patients with bile duct injury,aged from 31 to 68 years,with an average age of 47 years.Definitive repair surgery was performed according to different types of bile duct injury,and questionnaire of HRQOL was conducted preoperatively and one year after operation.There were 18 males and 32 females of 50 patients without complications after LC,aged from 35 to 69 years,with an average age of 41 years.Questionnaire of HRQOL was conducted on LC patients without complications one year after operation.Observation indicators:(1) classification of bile duct injury;(2) intraoperative situations of definitive repair surgery;(3) postoperative situations of definitive repair surgery;(4) follow-up;(5) results of the SF-36 scale assessment.Follow-up was conducted by outpatient examination and telephone interview up to December 2018.Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months,and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed by the paired t test.Measurement data with skewed distribution were described as M (range),and count data were described as absolute numbers.Results (1) Classification of bile duct injury:of the 181 patients with bile duct injury,there were 64 cases of E1 type,70 cases of E2 type,35 cases of E3 type,9 cases of E4 type,and 3 cases of E5 type.(2) Intraoperative situations of definitive repair surgery:all the 181 patinets with bile duct injury underwent definitive repair surgery successfully,including 61 undergoing end-to-end biliary anastomosis,109 undergoing Roux-en-Y choledojejunostomy,11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis.There were 52 patients combined with hilar cholangioplasty.The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range,150.0-2 100.0 mL).There were 24 cases with blood transfusion and 18 cases with T-tube stent.(3) Postoperative situations of definitive repair surgery:40 of 181 patients had complications,including 14 cases of incisional infection,10 cases of bile leakage,8 cases of perihepatic effusion,7 cases of pulmonary infection,and 1 case of abdominal hemorrhage.The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis,and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment.Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range,6.0-34.0 days).There was uo perioperative death occurred.(4) Follow-up:157 of 181 patients were followed up for 8.2-201.3 months,with a median follow-up time of 92.7 months.Twenty-eight patients had anastomotic stricture recurred,16 of which were treated with reoperation,10 were treated with endoscopic stent implantation,and 2 cases were treated with balloon dilatation in interventional department;the stricture was repaired again in all cases.Thirteen patients had recurrent cholangitis,showing no obvious anastomotic stricture on MRCP,and symptoms can be effectively controlled after conservative treatment.(5) Results of the SF-36 scale assessment:181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery,and 157 completed one year after definitive repair surgery.All the 50 patients without complications completed SF-36 scales one year after LC.The scores of HRQOL in physiological function,role functioning,somatic pain,general health,vitality,social function,emotional function,mental health,the scores of physical component summary,and mental component summary of 181 patients with bile duct injury before surgery were 79±15,65±12,40±17,42±14,59±20,27±15,48±23,56±22,60±11,and 56±11,respectively.The above indices one year after definitive repair surgery were 87±10,78±15,71±20,64±20、68± 19,70 ± 25,67 ± 21,69 ± 23,71 ± 13,68 ± 15,respectively.The above indices of 50 patients without complications one year after LC were 90±13,81±20,87±16,72±20,73±15,86±17,79±22,77±19,82±18,79 ± 18,respectively.The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051,2.016,3.875,3.014,2.563,3.225,2.964,2.357,2.150,2.203,P＜0.05).The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817,2.206,3.641,3.112,3.202,3.310,3.011,2.899,2.150,2.118,P＜0.05).There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t =2.014,2.011,P＜0.05),and no significant difference in the physiological function,role functioning,somatic pain,vitality,social function,or emotional function between the two groups (t=0.852,0.915,0.907,1.102,1.284,1.120,0.863,1.109,P＞0.05).Conclusion Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.