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.
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.
Authors: Steve M M de Castro; Koert F D Kuhlmann; Olivier R C Busch; Otto M van Delden; Johan S Laméris; Thomas M van Gulik; Hugo Obertop; Dirk J Gouma Journal: J Gastrointest Surg Date: 2005-11 Impact factor: 3.452
Authors: Gabriel E Gondolesi; Giovanni Varotti; Sander S Florman; Luis Muñoz; Thomas M Fishbein; Sukru H Emre; Myron E Schwartz; Charles Miller Journal: Transplantation Date: 2004-06-27 Impact factor: 4.939