BACKGROUND: Bile duct injury is a complex and serious complication whose frequency has not diminished. A bilidigestive anastomosis (Roux-en-Y hepaticojejunostomy) is usually needed after complex injuries. Placement of an anastomotic stent is a matter of debate and to our knowledge there is no study that compares the results between stenting and not stenting the anastomosis. DESIGN: A retrospective review of medical records of patients operated on for biliary reconstruction after iatrogenic injury. SETTING: Tertiary care academic university hospital. PATIENTS: A comparative study was performed of patients operated on between 1995 and 1999, who were referred to our hospital for acute or elective reconstruction of the biliary tract following iatrogenic injury. All patients underwent Roux-en-Y hepaticojejunostomy. The patients were divided into 2 groups: those who underwent Roux-en-Y hepaticojejunostomy with a transanastomotic stent and those who underwent Roux-en-Y hepaticojejunostomy without a transanastomotic stent. MAIN OUTCOME MEASURES: Operative mortality, anastomotic dysfunction, biliary fistula, reoperations, postoperative complications, postoperative liver function tests. RESULTS: Sixty-three patients with high and complex biliary injuries (Bismuth type III, IV; Strasberg D, E). Thirty-seven cases had reconstruction with the placement of a transanastomotic stent and 26 did not have a stent placed. No operative mortality was observed. The postoperative outcomes of both groups were compared and no differences found. Good results were observed in more than 80% of the patients. Reoperations were more frequent in the nonstented group (15% vs. 5%) and complications were more frequent in the stented group (16% vs. 7%). CONCLUSIONS: Good results are obtained with a Roux-en-Y hepaticojejunostomy after complex injuries. The use of transanastomotic stents has to be selective according to the individual characteristics of each patient and the experience of each surgeon. We recommend their use when unhealthy (ie, ischemic, scarred) and small ducts (<4 mm) are found.
BACKGROUND:Bile duct injury is a complex and serious complication whose frequency has not diminished. A bilidigestive anastomosis (Roux-en-Y hepaticojejunostomy) is usually needed after complex injuries. Placement of an anastomotic stent is a matter of debate and to our knowledge there is no study that compares the results between stenting and not stenting the anastomosis. DESIGN: A retrospective review of medical records of patients operated on for biliary reconstruction after iatrogenic injury. SETTING: Tertiary care academic university hospital. PATIENTS: A comparative study was performed of patients operated on between 1995 and 1999, who were referred to our hospital for acute or elective reconstruction of the biliary tract following iatrogenic injury. All patients underwent Roux-en-Y hepaticojejunostomy. The patients were divided into 2 groups: those who underwent Roux-en-Y hepaticojejunostomy with a transanastomotic stent and those who underwent Roux-en-Y hepaticojejunostomy without a transanastomotic stent. MAIN OUTCOME MEASURES: Operative mortality, anastomotic dysfunction, biliary fistula, reoperations, postoperative complications, postoperative liver function tests. RESULTS: Sixty-three patients with high and complex biliary injuries (Bismuth type III, IV; Strasberg D, E). Thirty-seven cases had reconstruction with the placement of a transanastomotic stent and 26 did not have a stent placed. No operative mortality was observed. The postoperative outcomes of both groups were compared and no differences found. Good results were observed in more than 80% of the patients. Reoperations were more frequent in the nonstented group (15% vs. 5%) and complications were more frequent in the stented group (16% vs. 7%). CONCLUSIONS: Good results are obtained with a Roux-en-Y hepaticojejunostomy after complex injuries. The use of transanastomotic stents has to be selective according to the individual characteristics of each patient and the experience of each surgeon. We recommend their use when unhealthy (ie, ischemic, scarred) and small ducts (<4 mm) are found.
Authors: Johanna M Laukkarinen; Juhani A Sand; Pierce Chow; Hanne Juuti; Minna Kellomäki; Päivi Kärkkäinen; Jorma Isola; Sidney Yu; Satchithanantham Somanesan; Irene Kee; In Chin Song; Teck Hin Ng; Isto H Nordback Journal: J Gastrointest Surg Date: 2007-06 Impact factor: 3.452
Authors: Beata Jabłońska; Paweł Lampe; Marek Olakowski; Zygmunt Górka; Andrzej Lekstan; Tomasz Gruszka Journal: J Gastrointest Surg Date: 2009-03-06 Impact factor: 3.452
Authors: Jason K Sicklick; Melissa S Camp; Keith D Lillemoe; Genevieve B Melton; Charles J Yeo; Kurtis A Campbell; Mark A Talamini; Henry A Pitt; JoAnn Coleman; Patricia A Sauter; John L Cameron Journal: Ann Surg Date: 2005-05 Impact factor: 12.969