Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury

Abstract

Biliary reconstruction affords satisfactory long-term outcome. The likelihood of needing the access loop for radiological intervention is dependent on the Bismuth level. The authors recommend that an access loop be constructed in all patients with Bismuth level III and IV injuries.

Lesão iatrogênica de vias biliares

“…Representando os pacientes da capital, somente 10% dos casos, o que demonstra a necessidade de maior experiência e treinamento cirúrgico dos médicos do interior dos estados para que esta grave lesão seja evitada ou pelo menos minimizada. Em relação ao procedimento cirúrgico, a literatura aponta a hepático-jejunostomia em "Y" de Roux como a melhor e mais freqüentemente empregada opção terapêutica 3,9,10,14,20,[24][25][26] . As lesões do presente estudo foram corrigidas através de hepáti-co-jejunostomia em "Y" de Roux em 70% dos casos (sete pacientes) e de anastomose colédoco-duodenal nos três casos restantes.…”

Laparoscopic hepaticojejunostomy after bile duct injury

“…In order to gain future access to the HJ, we created an enteropexy of the blind segment of the jejunal biliary limb beneath the subxiphoid incision port (access loop), as other authors have previously described [13,14]. Percutaneous endoscopic rehabilitation of the strictured HJ could be performed through this limb with endoscopic techniques when needed.…”

Management of major bile duct injuries after laparoscopic cholecystectomy

“…Their management is highly individualized. Reports of the long-term results of surgical vs endoscopic managements are conflicting [2,9].…”