Application of hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in the treatment of high level bile duct injuries

Abstract

Objective To study hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in treatment of high level bile duct injuries (BDI). Methods From January 2000 to January 2018, eleven patients with high level BDI caused by laparoscopic cholecystectomy (LC) were treated in Mianyang Central Hospital with hemihepatectomy combined with a circular-stretching suturing technique in the bile duct anastomosis. The hilar confluence was involved in all these patients. A total of six patients had combined right hepatic artery injury with 1 having associated right portal vein injury. A total of five patients had developed right liver atrophy. The median time interval from LC to hepatectomy was 17.0(2.0~61.0) months. The number of previously attempted biliary repairs was 1~4 times (median 2 times). The bile duct anastomosis was performed by the circular-stretching suturing technique. Results There was no perioperative death. One patient underwent left hemihepatectomy and 10 patients right hemihepatectomy. Roux-en-Y hepaticojejunostomy was carried out in 9 patients, and bile duct end-to-end anastomosis in 2 patients. The operation time was (245.9±87.4) min, intraoperative blood loss (655.7±413.6) ml, and the median postoperative hospital stay 12.0(7.0~29.0) days. Five patients developed complications. The median follow-up was 47.0(15.0~89.0) months. One patient developed anastomotic stenosis and 1 patient had cholangitis. The remaining 9 patients were well. Conclusion After adequate preoperative preparation, patients who were treated with hemihepatectomy combined with the circular-stretching suturing technique for bile duct anastomosis to treat high level BDI achieved good results. Key words: Bile ducts; Hepatectomy; Cholecystectomy, laparoscopic; Wounds and injuries; Bile leakage