Abstract | BACKGROUND:
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.
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Authors | Riccardo Memeo, Andrea Belli, Michael D Kluger, Claude Tayar, Alexis Laurent, Daniel Cherqui |
Journal | World journal of surgery
(World J Surg)
Vol. 36
Issue 1
Pg. 129-35
(Jan 2012)
ISSN: 1432-2323 [Electronic] United States |
PMID | 22037690
(Publication Type: Evaluation Study, Journal Article)
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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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