H Rudolph1, F Neser2, M Berger1, J Boese-Landgraf1. 1. Klinik für Allgemein- und Viszeralchirurgie, Klinikum Chemnitz gGmbH, Deutschland. 2. Klinik für Innere Medizin II, Klinikum Chemnitz gGmbH, Deutschland.
Abstract
Background: Roux-Y hepaticojejunostomy is currently the standard surgical procedure for the reconstruction of the bile duct after iatrogenic transection in laparoscopic cholecystectomy. However, about 30 % of all hepaticojejunostomies develop a stenosis after some time and in 7 % a cholangiocellular carcinoma occurs. Therefore, alternative procedures have been investigated. Patients: Between September 2009 and October 2013 an iatrogenic bile duct lesion was treated in 6 consecutive patients by using the pedicled umbilical vein. The median follow-up period was 16 months. Methods: In 3 cases, the bile duct lesion was detected during cholecystectomy and reconstructed in the same session. In the other 3 cases, the reconstruction was performed between the fourth and the seventh day after cholecystectomy. The pedicled umbilical vein was used as a patch in 4 cases and as an interposition graft in the other 2 cases. Results: Two out of 6 patients suffered from cholangitis after bile duct reconstruction, which was brought to complete remission by temporary endoscopic dilatation treatment. Conclusion: The use of the pedicled umbilical vein is a new surgical option for the treatment of iatrogenic bile duct lesions and seems to provide advantages over hepaticojejunostomy regarding the development and treatment of anastomotic stenosis and the risk of cholangiocellular carcinoma. Georg Thieme Verlag KG Stuttgart · New York.
Background: Roux-Y hepaticojejunostomy is currently the standard surgical procedure for the reconstruction of the bile duct after iatrogenic transection in laparoscopic cholecystectomy. However, about 30 % of all hepaticojejunostomies develop a stenosis after some time and in 7 % a cholangiocellular carcinoma occurs. Therefore, alternative procedures have been investigated. Patients: Between September 2009 and October 2013 an iatrogenic bile duct lesion was treated in 6 consecutive patients by using the pedicled umbilical vein. The median follow-up period was 16 months. Methods: In 3 cases, the bile duct lesion was detected during cholecystectomy and reconstructed in the same session. In the other 3 cases, the reconstruction was performed between the fourth and the seventh day after cholecystectomy. The pedicled umbilical vein was used as a patch in 4 cases and as an interposition graft in the other 2 cases. Results: Two out of 6 patients suffered from cholangitis after bile duct reconstruction, which was brought to complete remission by temporary endoscopic dilatation treatment. Conclusion: The use of the pedicled umbilical vein is a new surgical option for the treatment of iatrogenic bile duct lesions and seems to provide advantages over hepaticojejunostomy regarding the development and treatment of anastomotic stenosis and the risk of cholangiocellular carcinoma. Georg Thieme Verlag KG Stuttgart · New York.