Anastomosis Of Hepatic Duct Research Articles

Robotic Hepaticojejunostomy After Open Hepaticoduodenostomy

Introduction: Roux-en-Y hepaticojejunostomy (HJ) is the gold standard to repair iatrogenic bile duct injury. Robotic surgery seems a viable surgical approach, as it permits the sophisticated movements required for anastomotic technique through 3D visualization, endowrist manipulation and tremor filtration. This report describes a robotic HJ after open hepaticoduodenostomy (HD). Method: The patient was a 23-year-old female, with a medical history of laparoscopic cholecystectomy followed by an open HD on the right hepatic duct after an iatrogenic bile duct injury. She presented recurrent cholangitis episodes, caused by a stenosis on the HD right hepatic duct anastomosis. After adhesiolysis, the HD stenosis was identified and resected up to the orifice of the right anterior and right posterior sectoral duct. Following resection of the stenotic area the opening at the duodenum was closed. A bilioenteric reconstruction was performed through a Roux-en-Y suprahilar HJ, in which both the posterior and anterior sectoral branch were implanted on the jejunal loop. Continuity of the gastrointestinal tract was restored by a jejunojejunostomy through an end-to-side manual anastomosis. The common limb was tattooed with ink in order to aid orientation in future endoscopic interventions. Results: Operative time was 200 minutes and blood loss 20 cc. No intraoperative complications were encountered. The postoperative course was complicated by a bile leak with spontaneous resolution after one week and gastroparesis requiring temporary placement of a nasogastric tube. Discharge happened on postoperative day 14. Conclusions: Robotic HJ is a safe and feasible technique for complex bile duct reconstructions following open hepatobiliary surgery.

Diagnosis and treatment modalities of hilar biliary duct stricture in hepatic cystic echinococcosis after endocystectomy.

Aim: Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities. Methods: Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up. Results: Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient. Conclusion: Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture.

Restoration and reconstruction of extrahepatic bile ducts in high strictures using enteric autotransplant of variable diameter

To develop technique incorporating favorable aspects of gastroenterostomy in common hepatic duct anastomosis, providing bile drainage into duodenum and preventing duodenobiliary reflux. It is presented developed operations for high strictures of extrahepatic bile ducts using enteric autotransplant of variable diameter. Good remote postoperative results were observed in 10 survived patients. There were no recurrence of stricture, cholangitis and normal biochemical parameters were observed. It has been proved that suggested methods may be alternative to Roux-en-Y hepaticojejunostomy.

Biliary Complications After Orthotopic Liver Transplantation: A 5-Year Experience

Introduction Biliary complications, particularly bile duct stenosis or leak, remain the “Achilles' heel” of orthotopic liver transplantation (OLT), significantly increasing the risk of graft loss and recipient death. The aim of the study was to retrospectively analyze biliary complications over a 5-year experience seeking to identify risk factors for these complications. Material and Methods Eighty-seven OLT performed in 84 recipients were included in the analysis. In all cases but one, we performed an end-to-end hepatic duct anastomosis with a 7-0 running suture under 2.5× magnification. Results Biliary complications developed after 17.2% OLT: anastomosis site stenosis (10.3%), multiple stenoses (5.7%), or bile duct necrosis (1.1%). A bile leak was not observed. Two recipients died from biliary sepsis. Among the patients with biliary complications, there was an higher rate of hepatic artery problems (33.3% vs 2.7%; P < .01), and a longer anhepatic phase (85 vs 72 minutes; P < .01). We performed endoscopic treatment in 73% and percutaneous drainage in 6.6% of recipients. Good treatment results were achieved in 36.4% of cases with biliary complications whereas they were satisfactory in 27.3%. Five patients with biliary complications required re-transplantation. Conclusions A bile duct anastomosis performed end-to-end with a running suture under magnification decreased the risk of bile leakage after OLT. A prolonged anhepatic phase or an hepatic artery thrombosis or stenosis increased the risk of biliary complications after OLT.

Repair of a mal-repaired biliary injury: A case report

Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair (right to left hepatic duct anastomosis over the T-tube), with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepatico-jejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical mal-repair. We propose an algorithm for the treatment of early and late biliary injuries.

Treatment and prevention of biliary complications after living donor liver transplantation

Objective To discuss the treatment and prevention of bile duct complications after living donor liver transplantation. Methods The clinical data of 84 cases of living donor liver trans-plantation including 56 adult recipients and 28 pediatric recipients were analyzed. Amongst the 84 pa-tients, 66 had benign end-stage liver diseases and 18 hepatocellular carcinoma. Duct-to-duct biliary re-construction was performed in 50 cases. One recipient received an end-to-end and end-to-side anasto-mosis of hepatic duct of donor and hepatic duct and common bile duct of recipient and another under-went end-to-end anastomosis of hepatic duct of donor and hepatic duct and cystic duct of recipient while the other 32 cases hepaticojejunostomy. 4Fr or 6Fr stent was routinely inserted into bile duct af-ter biliary reconstruction and elicited from the anterior wall of common bile duct or lateral wall of jeju-nal caecum of recipient in all the 84 cases. Results Twenty-four cases had biliary complications and the incidence was 28.5 %. The incidence of biliary leakage was significantly different between duct-to-duct reconstruction and hepaticojejunostomy (8.3% νs 16.7%, P＜0.05). The incidence of biliary stricture was markedly different between duct-to-duct reconstruction and hepaticojejunostomy (50% νs 16.7%, P＜0.05). The biliary complication was remarkably different between single hepatic duct and multiple hepatic duct (20.8% νs 79.2, P＜0.05). Four cases of biliary leakage were cured with con-servative treatment and the other 4 need reoperation. Four cases of biliary stricture were cured by way of endoscopic dilation and nose-biliary drainage, 2 cases turned to be better. Six cases were cured by conversion of hepaticojejunostomy and 4 turned to be better by way of percutaneous transhepatic biliar-y dilation and drainage. The recipients didn't die of biliary complications. Conclusion It is necessary to decrease the biliary complications after living donor liver transplantation, to be satisfactory blood supply and anastomotic technigue and select appropriato biliary reconstruction. Key words: Liver transplantation; Bile duct; Complication; Treatment; Prevention

Survival and quality of life after bile duct reconstruction for iatrogenic injury

Background The overall acceptance of laparoscopic cholecystectomy has increased the number of operations performed worldwide. Duct injury continues to occur with a prevalence of 0.3–0.6%. The present paper evaluates the survival and quality of life of patients following operative repair. Methods In a 9-year period, 122 patients underwent bile duct reconstruction. Of these patients (mean age 38 years), 80% sustained the injury during an open operation and 42 during a laparoscopic operation. Quality of life was evaluated in the postoperative period. Results All 122 patients were treated surgically by means of Roux-en-Y hepaticojejunostomy. Transhepatic stents were used in all but 10 cases. Six patients had independent left and right hepatic duct anastomosis, and 24 had partial resection of segment IV of the liver to improve exposure of the hilus. Mortality rate was 1.7%. After removal of the transhepatic stent, in 16% of cases radiological manipulation was required to remove debris and stones or to dilate the anastomosis. Of the total patients, 101 (83%) were completely rehabilitated, both clinically and biochemically. Discussion Bile duct injury has a good prognosis in specialist tertiary care centres. Hepaticojejunostomy is the procedure of choice with a transhepatic stent when needed. Full rehabilitation can be achieved in over 80% of patients.

Adenocarcinoma of the common bile duct with resection, anastomosis of the hepatic duct to the cystic duct and cholecystogastrostomy

A CASE of papihary adenocarcinoma of the common biIe duct is presented with resection of the growth, anastomosis of the common hepatic duct to the cystic duct and estabhshment, with a cholecystogastrostomy, of continuity with the gastrointestinal tract. A short review of the Iiterature is aIso presented. In this study, cancer of the ampuha of Vater is not considered. Carcinoma of the extrahepatic biIe ducts differs in many respects from the more common carcinoma of the gaIIbIadder. “The reIative infrequency of gaII stones (22 per cent in 264 cases) and the predominance of the disease in males 50/35 contrast carcinoma of the Iarger bile passages with that of the gaILbladder.“’ AIthough carcinoma of the extrahepatic biIe ducts is considered quite rare by most observers, a review of 46,442 autopsies2+ reveaIs 123 cases of primary cancer in the extrahepatic biIe ducts. This gross incidence of .26 per cent means that this disease was found in about one out of every four hundred patients coming to autopsy in this series. PaInar reported 103 cases of cancer in the biIiary passages in over 53,000 necropsies-0.19 per cent of a11 autopsies or 2.2 per cent of al1 carcinomas found.7 An anaIysis of the Iiterature indicates that the most common site for cancer of the extrahepatic ducts (exchrsive of the ampuIIa of Vater) is the confluence of the cystic, common hepatic and common biIe ducts. Cancer of the common biIe duct occurs primariIy past middIe age (fifty to seventy). In many of the cases there is associated biliary tract disease: ChoIecystitis, cholangitis, cirrhosis, or stones. “AIthough primary carcinoma of the common biIe duct is comparativeIy a rare pathoIogica1 entity, it should be given consideration as a possibIe cause of persistent obstructive jaundice in a11 cases occurring past middle age.“* Carcinoma of the extrahepatic biIe ducts is of three types according to Ewing: diffuse, noduIar and viIIous. UsuaIIy the viIIous or papiIIary type of growth attains the Iargest size without severe obstructive symptoms, is of Iowest degree of maIignancy and is most amenabIe to surgica1 management. Metastasis from carcinoma of the biIe ducts is not common9 and occurs Iate. In MarshaII’s series of forty-nine cases, onIy tweIve showed metastasis-nine to Iiver, five to regional lymph nodes, three to pancreas and one to the Iungs. MarshaII, in specuIating on causes of maIignancy of the extrahepatic ducts, noted that if stones were the principa1 etioIogica1 factor, this disease shouId be more common in women than in men, but as aIready mentioned, the opposite is the case. Dick suggested that cancer of the common biIe duct might be due to Iong continued appIication of a carcinogenic agent acting on an hereditarily susceptibIe person. He postuIated that choIic acid, which is reIated chemicaIIy to known carcinogenic substances, might be this etioIogica1 factor.4 The symptoms and signs of cancer of the extrahepatic biIe tracts are those of obstructive biIiary disease and of malignancy. Among the earIy symptoms are vague gastric distress, Iassitude and fatigue, loss of appetite and loss of weight. Jaundice