Bilioenteric Anastomosis Research Articles

Hepatic recovery after biliary decompression of experimental obstructive jaundice

Obstructive jaundice was produced in 11 dogs by common bile duct ligation for 4 weeks, then biliary decompression was performed by bilioenteric anastomosis. Animals were regularly studied over the 2 months after decompression by the following methods: (1) serum biochemistry was monitored; (2) light microscopic changes in serial liver biopsies were graded; (3) the respiratory characteristics of isolated hepatic mitochondria, obtained by open liver biopsy, were studied using an oxygen microelectrode system; (4) in vivo handling of an hepatobiliary imaging agent (diisopropyl iminodiacetic acid) was studied by dynamic liver scintiscanning. None of these liver assessments were normalized after 7 to 10 days of biliary decompression. Our study suggests that biliary decompression of patients with extrahepatic biliary obstruction requires long periods of time to enable major recovery of the abnormal liver function induced by biliary obstruction.

Bilio-enteric anastomosis as a risk factor for postembolic hepatic abscesses

In 2 patients who had undergone pancreatoduodenectomy with choledochojejunostomy, a subsequently detected metastatic tumor of the liver was treated with transcatheter arterial embolization. Weeks later intrahepatic abscesses developed. Pathophysiologic processes that may lead to this complication of hepatic embolization are discussed.

DNA repair synthesis in primary culture of bovine bile duct epithelial cells induced by chemical agents in relation to bile duct cancer

Unscheduled DNA synthesis (UDS) was measured autoradiographically in a primary culture of extrahepatic bile duct epithelial cells of Holstein cows following exposure to chemicals known to be capable of developing bile duct cancers in experimental animals, i.e., N-methyl- N′-nitro- N-nitrosoguanidine (MNNG, CAS No. 70-25-7), N-ethyl- N′-nitro- N-nitrosoguanidine (ENNG, CAS No. 4255-77-6), 20-methylcholanthrene (MCA, CAS No. 56-49-5), N-nitrosodimethylamine (DMN, CAS No. 62-75-9) and aflatoxin B 1 (AFB 1, CAS No. 1162-65-8). MNNG and ENNG induced UDS without addition of S9 mixture. MCA elicited UDS only if S9 mixture was added. Regardless of the presence or absence of S9 mixture, DMN failed to induce UDS. DNA repair by AFB 1 was enhanced by the presence of S9 mixture. Therefore, for MNNG, ENNG and high doses of AFB 1 activation by the liver is not necessary to exert genotoxic effects and they seem to be capable of direct action on bile duct epithelial cells in the presence of a bilioenteric fistula or anastomosis.

Human amnion as a bioprosthesis for bile duct reconstruction in the pig

Despite technical advances in management, the complication of late stricture formation and biliary sepsis still occur in bile duct reconstruction. In an attempt to avoid bilioenteric anastomosis, which bypasses the biliary sphincter mechanism, various biologic and artificial materials have been employed clinically and experimentally to replace the damaged bile duct. No satisfactory biliary replacement material has yet been found. In the experimental model of bile duct stricture that has been presented, human amnion bile duct injuries mimicking those seen in clinical practice were repaired using human amnion as a free graft. Noncircumferential duct loss appeared to be satisfactorily repaired using amnion, and the amnion repair was found to be as good as or superior to plastic repair; however, circumferential duct loss was not adequately repaired with the amnion graft.

Biliary atresia in Zaria, Nigeria: a review

The true incidence of biliary atresia in Nigeria is unknown owing partly to incomplete investigation of jaundice in neonates and infants. During 13 years in Zaria, the diagnosis was histologically confirmed in 36 infants and children aged 2-20 months at the time of presentation. Laparotomy was performed in 26 but a bilio-enteric anastomosis was feasible in only 4 and did not establish bile flow. Fifteen patients died, 19 were lost to follow-up and are presumed dead, 2 are alive with persistent jaundice. In contrast, hepatic portoenterostomy performed before the age of 60 days has provided effective bile drainage in many infants in Japan and elsewhere and survival into adulthood is now possible. It is concluded that improvement in surgical care will depend on earlier presentation of children, perhaps through neonatal check-up clinics. Prompt evaluation of conjugated hyperbilirubinaemia would lead to early laparotomy for the Kasai operation to be attempted in selected cases.

Management of traumatic injuries to the extrahepatic biliary ducts

From 1978 through 1984, 13 patients with traumatic injuries to the extrahepatic biliary ducts were treated. Twelve of the 13 patients had penetrating wounds, and associated intraabdominal injuries were uniformly present. Multiple types of operative repair were successfully utilized, with the choice dictated by the patient's condition and the location and extent of the ductal injury. In stable patients with partial tears or small through-and-through injuries, lateral repair with or without T-tube stenting was used successfully. With ductal transections, an end-to-end anastomosis or a bilioenteric anastomosis was used. The Whipple procedure was reserved for complex periampullary injuries. Morbidity was related to the complexity of the ductal repair, whereas mortality (4 of 13 patients, 31 percent) was related to associated injuries.

Long-term results of surgical treatment for intrahepatic stones.

One hundred and nineteen patients with intrahepatic stones treated surgically in Nagasaki University Hospital from 1969 to 1984 were reviewed. The patients were divided into four types according to location of the stones and the presence or absence of stenotic lesions and/or localized dilatation of the intrahepatic bile ducts. Types I and II patients were treated with choledocholithotomy or choledochojejunostomy, while type III patients underwent hepatic resection and type IV patients were treated by partial hepatic resection with bilioenteric anastomosis, including extended hepatico-choledochojejunostomy. The majority of operative or early deaths belonged to type IV and residual stones were present in almost all patients. The long-term results for the 88 patients revealed that the rate of improvement was 100 per cent for type I, 87 per cent for type II, 83 per cent for type III and 84 per cent for type IV. In type IV, the most excellent results (92 per cent) were obtained by extended hepaticocholedochojejunostomy, especially with hepatectomy. It is suggested that extended hepaticocholedochojejunostomy with partial hepatic resection is a reasonable procedure for treating patients with type IV intrahepatic stones.

Intrahepatic pyogenic abscesses: Treatment by percutaneous drainage

During a 6 year period, 18 liver abscesses in 12 patients were identified by computerized tomography. Five patients had presumed hematogenous seeding. Five patients previously had bilioenteric anastomoses, stents, or both to relieve obstructive jaundice. Four patients with abscesses had recent abdominal operations. Diagnosis was established by guided needle aspiration and treatment was provided by percutaneous catheter drainage. Organism-specific antibiotics were administered to all patients. Patients were evaluated for recurrence by serial computerized tomographic studies and were clinically followed up for a minimum of 15 months. Ten of 12 patients (83 percent) and 16 of 18 abscesses (89 percent) were successfully treated by percutaneous catheter drainage. Two failures required operative intervention. In summary, the low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggests that this therapy be tried before operative intervention is considered.

Granular cell myoblastoma of the extrahepatic biliary system

We have reported our experience with two cases of granular cell myoblastoma, bringing the total number of cases to 29. Granular cell myoblastoma of the extrahepatic biliary system is a rare benign tumor that affects black women predominantly. Both black men in this study had multiple lesions involving the skin and biliary system. Surgery is necessary for tissue diagnosis and curative resection. Tumors involving the common bile duct or common hepatic duct require wide local excision and bilioenteric anastomosis. The cause is uncertain, but present data indicate a neuroectoderm origin.

Choice of treatment for hepatolithiasis based on pathological findings.

AbstractThe results of surgical treatment in 56 patients with hepatolithiasis are reported including a follow‐up study on 53 patients who survived more than 1 year (median, 5 years and 8 months). Patients were treated by 4 different procedures, i.e., common duct exploration in 32 patients, hepatic resection in 13 patients, hepatic resection with intrahepatic cholangiojejunostomy in 6 patients, and endoscopic stone removal in 5 patients. These procedures were combined with additional procedures, i.e., sphincteroplasty and bilioenteric anastomosis when necessary. There were no operative deaths. The stones were completely removed in 51.8% of the patients. Follow‐up study for 1 to 10 years showed good results in 70.8% of the patients. Residual stones were often observed in the cases with stricture at the liver hilum and this led to poor results at follow‐up. The results of various procedures were evaluated in relation to the prevailing pathology such as bile duct stricture and the location of stones.

Recurrent biliary stricture: Patterns of recurrence and outcome of surgical therapy

We analyzed the course of 50 consecutive patients with recurrent biliary stricture (at least one previous repair) to determine the pattern of recurrence and the outcome of additional treatment. The presenting manifestations included cholangitis in 40 percent of the patients, jaundice in 30 percent, and pain in 17 percent. Sixty-seven percent had become symptomatic within 2 years of their previous repair and 90 percent within 7 years. Ten (20 percent) patients were treated by end-to-end anastomosis of the bile duct, and 40 (80 percent) patients by bilioenteric anastomosis (hepaticojejunostomy in 32 patients and hepaticoduodenostomy in 8). Two patients (4 percent) died postoperatively. After repair of recurrent stricture, 38 (76 percent) patients had no further symptoms. In 11 (22 percent), another recurrence developed: 6 (55 percent) of the 11 did well after another operation and in 4 (36 percent), a third recurrence developed which was successfully treated by a fourth operation in 3 of the patients. Thus, two thirds of recurrent strictures were evident by 2 years and 90 percent by 7 years. The chance of another recurrence was about 25 percent after treatment of a first recurrence. There was no evidence that prolonged stenting contributed to a good result. Treatment of recurrent stricture should consist of anastomosis between the duct and the intestine, usually a hepaticojejunostomy.

Repair of benign bile duct stricture.

Cases of benign bile duct stricture treated during the past ten years were reviewed in reference to the location of the bile duct stricture, the method of repair and their long-term results. Common hepatic duct was the most frequent site of bile duct involved. Bilioenteric anastomosis in the form of retrocolic hepaticojejunostomy (Roux-Y) was the method of repair most frequently used. Brief survey was made on the current literatures concerning the methods of repair of benign bile duct stricture.