End-to-end ductal anastomosis in biliary reconstruction: indications and limitations

Jabłońska, Beata

doi:10.1503/cjs.016613

Cited by 25 publications

(23 citation statements)

References 43 publications

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“…Several conditions must be met for proper healing of each biliary anastomosis. The anastomosed edges should be healthy; there should be no inflammation, ischemia, or fibrosis; and the anastomosis should be tension-free and properly vascularized [59]. Refreshing of the proximal and distal stumps as far as the tissues are healthy and without inflammation should be performed.…”

Section: Principles Of Surgical Managementmentioning

confidence: 99%

“…Contradictory meta-analyses regarding the usefulness of a T-tube in LT performing end-to-end ductal anastomosis can be found in the literature [60,61]; therefore, the application remains controversial. There is also a second type of T-tube available for biliary drainage, the so-called internal Y-drainage [59]. External T-drainage involves using a typical T-tube with insertion of its short branches into the bile duct, and conducting of its long branch through the abdominal wall outside.…”

Section: Principles Of Surgical Managementmentioning

confidence: 99%

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Bile Duct Injury after Cholecystectomy: Surgical Therapy

Renz¹,

Bösch²,

Angele³

2017

Visc Med

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Background: Iatrogenic bile duct injuries (IBDI) after laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery. The most important aspect regarding this issue is the prevention of IBDI during index cholecystectomy. Once it occurs, early and accurate diagnosis of IBDI is very important for surgeons and gastroenterologists, because unidentified IBDI may result in severe complications such as hepatic failure and death. Laboratory tests, radiological imaging, and endoscopy play an important role in the diagnosis of biliary injuries. Methods: This review summarizes and discusses the current literature on the management of IBDI after LC from a surgical point of view. Results and Conclusion: In general, endoscopic techniques are recommended for the initial diagnosis and treatment of IBDI and are important to classify them correctly. In patients with complete dissection or obstruction of the bile duct, surgical management remains the only feasible option. Different surgical reconstructions are performed in patients with IBDI. According to the available literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and is recommended by most authors. Long-term results are most important in the assessment of effectiveness of IBDI treatment. Apart from that, adequate diagnosis and treatment of IBDI may avoid many serious complications and improve the quality of life of our patients.

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Section: Principles Of Surgical Managementmentioning

confidence: 99%

Section: Principles Of Surgical Managementmentioning

confidence: 99%

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Renz¹,

Bösch²,

Angele³

2017

Visc Med

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“…Gastrointestinal bleeding has been observed in 2.4%‐25% of recipients and is mostly related in early postoperative period (within 30 days) to variceal bleeding or peptic ulcer bleeding . Also, bleeding from Roux‐en‐Y anastomosis (utilized in case of biliary reconstruction for primary sclerosing cholangitis and biliary atresia) is a rare but early postoperative complication . Bowel ischemia, infectious enterocolitis, post‐transplant lymphoproliferative disease (PTLD), or graft‐versus‐host diseases are causes of late GI bleeding .…”

Section: Etiologymentioning

confidence: 99%

Abdominal emergencies after liver transplantation: Presentation and surgical management

Cesaretti

Burgio

Bian

2017

Clinical Transplantation

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With an increasing number of liver transplantation (LT) and an enhanced overall survival, LT recipients are more likely to be admitted in emergency departments of general hospitals. Yet, in LT recipients, common but also benign symptoms may reveal a LT-related (or not) severe condition. To improve management of LT recipients by emergency physicians and general surgeons and potentially improve long-term outcomes, a clinical review was performed. Overall, CT scan and blood tests should be systematically performed. Immunosuppressive side effects should be excluded using blood tests. LT-related complications are more likely to occur during the first three months after LT, including mainly bile leak, arterial aneurysm, and pseudoaneurysm. Patients should be referred in emergency to tertiary centers. Non-LT-related complications and common abdominal conditions may also be diagnosed in LT recipients. Except in case of diffuse peritonitis or in hemodynamically unstable patients when surgical procedure should be performed, most conditions should be reassessed regarding the immunosuppressive treatment and the adhesive abdominal cavity.

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“…Following this and some other larger institutional reviews, different technical adaptations have been made in order to reduce the incidence of BTCs, such as: Adequate flushing of the bile duct at procurement. Shortening of donor and recipient bile duct stumps in order to eliminate ischemic zones as much as possible. Donor cystic duct exclusion without suturing or inclusion, with or without endoluminal septoplasty. Side‐to‐side duct‐to‐duct anastomosis aiming to avoid potential ischemic bile duct stumps. Application of purse‐string suture around the T‐tube and delayed withdrawal until 3 months after transplant. …”

Section: Btc and Deceased Donor Liver Transplantation (Ddlt)mentioning

confidence: 99%

“…Although seemingly sound, the use of a T‐tube remains debated due to the fact that almost no prospective, randomized trials have been performed and the diagnosis of a biliary complication is based on abnormal liver tests rather than on systematic biliary imaging . Some studies are in favor of the systematic use of biliary stenting, although some studies are not.…”

Section: Btc and Deceased Donor Liver Transplantation (Ddlt)mentioning

confidence: 99%

Biliary tract complications and its prevention

Lerut

2015

Liver Transpl

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End-to-end ductal anastomosis in biliary reconstruction: indications and limitations

Cited by 25 publications

References 43 publications

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Abdominal emergencies after liver transplantation: Presentation and surgical management

Biliary tract complications and its prevention

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