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Duct-to-duct biliary reconstruction during complex hepatectomy: a useful technique in selected cases.

AbstractBACKGROUND:
Roux-en-Y anastomosis is the standard of care for biliary reconstruction. Yet, a direct bilio-biliary anastomosis preserves the normal sphincter mechanism and endoscopic access to the biliary tree for diagnostic and therapeutic purposes. Duct-to-duct biliary reconstruction is widely used in liver transplantation. The objective of this study was to analyze the feasibility and results of duct-to-duct biliary reconstruction in the setting of complex hepatic resection with limited biliary confluence involvement.
METHODS:
We identified patients from our prospectively maintained database that underwent major hepatic resection and bile duct resection with a concomitant direct duct-to-duct biliary anastomosis. Postoperative oncological and functional biliary outcomes were analyzed.
RESULTS:
Ten patients were studied. In 9 cases, a biliary stent was left in place to decompress the anastomosis. Two patients developed a biliary fistula: one resolved spontaneously and the other required percutaneous drainage and an endoscopic biliary stent. This latter patient (the only nonstented patient) also developed a biliary stricture that was treated endoscopically. With a mean follow-up of 22 months, no other biliary-related complications were recorded. No patients had a recurrence at the biliary reconstruction site only. In the setting of multifocal hepatic recurrence presenting with jaundice, two patients were palliated by interventional endoscopy.
CONCLUSIONS:
For hepatectomy requiring a short resection of the bile duct or for high bile duct injury during complex hepatectomy, a tension-free, well-vascularized duct-to-duct reconstruction over a stent is a suitable option that offers good oncological clearance of the bile duct and satisfactory functional results.
AuthorsRiccardo Memeo, Andrea Belli, Michael D Kluger, Claude Tayar, Alexis Laurent, Daniel Cherqui
JournalWorld journal of surgery (World J Surg) Vol. 36 Issue 1 Pg. 129-35 (Jan 2012) ISSN: 1432-2323 [Electronic] United States
PMID22037690 (Publication Type: Evaluation Study, Journal Article)
Topics
  • Adult
  • Aged
  • Anastomosis, Surgical
  • Bile Ducts (surgery)
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Hepatectomy (methods)
  • Humans
  • Liver Neoplasms (surgery)
  • Male
  • Middle Aged
  • Postoperative Complications
  • Stents
  • Treatment Outcome

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