Long-term Evaluation of Biliary Reconstruction After Partial Resection of Segments IV and V in Iatrogenic Injuries

Mercado, Miguel Ángel; Chan, Carlos; Orozco, Héctor; Villalta, José M.; Barajas-Olivas, Alexandra; Eraña, Javier; Domínguez, Ismael

doi:10.1016/j.gassur.2005.07.003

Cited by 46 publications

(29 citation statements)

References 11 publications

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“…Injuries near the bifurcation or at the bifurcation level, and those in a devascularized common hepatic duct need a high repair and may require this technique. We found that this maneuver facilitated the performance of a high-quality anastomosis for one-third of the cases in our series [7].…”

supporting

confidence: 51%

Early versus late repair of bile duct injuries

Mercado

2006

Surg Endosc

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Biliary injuries associated with laparoscopic cholecystectomy occur at a constant rate of 0.3% to 0.6%. The spectrum of injures ranges from small leaks of bile to complete section of the main ducts requiring bilioenteric reconstruction. The goal of biliary reconstruction is to obtain a high-quality bilioenteric anastomosis that will not malfunction for a long time. No prospective, controlled, randomized trial (evidence level 1) has been conducted that shows whether an early repair is better than a late one. The timing of the operative procedure should be individualized. A complete examination of the patient should be performed to identify the type of injury and coexistent comorbidities. For septic patients and those with multiple organ dysfunction syndrome, the repair should be delayed. Maneuvers to drain the bile ducts can be performed to relieve jaundice and cholangitis in these patients. For these cases, the surgery should be delayed. If a stable patient is found, without comorbidities, the operation can be scheduled earlier. Subhepatic drains should not be left for a long period because of the risk for intestinal fistulization. If needed, they should be changed for transhepatic stents. High-quality bilioenteric anastomoses are performed with fine absorbable sutures for healthy ducts (nonscarred, noninflamed, nonischemic) in a wide opening, with anastomosis of a (tension-free) defunctionalized jejunal limb. Individualization of the patient is the best rule.

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supporting

confidence: 51%

Early versus late repair of bile duct injuries

Mercado

2006

Surg Endosc

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“…Laurent et al [27] and Mercado et al [29] emphasise that hepaticojejunostomy requires a good exposition to achieve a safe and good vascularised anastomosis. Similar to the reported approach of Laurent et al [27] we planned our liver resections with the aim to perform a single duct anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Hepatic resection for patients with cholecystectomy related complex bile duct injury

et al. 2010

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“…In some cases lowering the hilar plate provided adequate ducts exposition for the anastomosis. In order to obtain a tension free, wide anastomosis (and as a result having more room for the intestinal loop) partial resection of segments Ⅳ and Ⅴ was done [23] . Routine extension of the anterior opening of the common bile duct with direction to the left duct was done, particularly for thin ducts [24] .…”

Section: Institutional Experiencementioning

confidence: 99%

Classification and management of bile duct injuries

Mercado¹

2011

WJGS

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To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GⅠ-1990-99 (33 cases), G Ⅱ-2000-2004 (139 cases) and GⅢ-2004-2008 (140 cases). All patients were treated with a Roux en Y hepatojejunostomy. A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001). Partial segment Ⅳ and Ⅴ resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis). Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period.The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair. Even interested and tertiary care centers have a learning curve.

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Long-term Evaluation of Biliary Reconstruction After Partial Resection of Segments IV and V in Iatrogenic Injuries

Cited by 46 publications

References 11 publications

Early versus late repair of bile duct injuries

Early versus late repair of bile duct injuries

Hepatic resection for patients with cholecystectomy related complex bile duct injury

Classification and management of bile duct injuries

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