To Stent or Not to Stent Bilioenteric Anastomosis After Iatrogenic Injury

Mercado, Miguel Ángel; Chan, Carlos; Orozco, Héctor; Cano-Gutiérrez, Gumaro; Chaparro, Juan Manuel; Galindo, Erick; Vilatobá, Mario; Samaniego-Arvizu, Gilberto

doi:10.1001/archsurg.137.1.60

Cited by 70 publications

(77 citation statements)

References 14 publications

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“…There is still controversy over the timing of tube removal, ranging from 2 months to 1 year after surgery. [8][9][10]25,35,36 We generally removed the tube 6 months after surgery, depending on condition of the bile duct during surgery, the bile duct as shown by cholangiography and electronic choledochoscopy 6 months after surgery and the general condition of the patient (Figure 2). …”

Section: Liu H Et Al Int Surg J 2015 May;2(2):179-186mentioning

confidence: 99%

Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

et al. 2015

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INTRODUCTIONBile Duct Injury (BDI) remains to be a serious complication of biliary surgery. The reported incidence of major BDI is about 0.5% [1][2][3][4][5] and is still on the rise with the advent of laparoscopic techniques, seriously affecting the patient's quality of life. 6,7 There are controversies over optimal strategy for surgical management of BDI, especially for biliary strictures after BDI. Biliary reconstruction and Roux-en-Y hepaticojejunostomy (RYHJ) are believed to be the choice of treatment in most cases, 3,[8][9][10][11][12] but few reports have specifically analyzed the outcomes. The purpose of this study was to determine the ABSTRACT Background: There are controversies over the optimal surgical strategy for the management of complicated biliary strictures after Bile Duct Injury (BDI). The purpose of this study is to investigate the efficacy of biliary reconstruction and Roux-en-Y hepaticojejunostomy (RYHJ) for this condition. Methods: Included in this single-center retrospective clinical study were 10 patients with the diagnosis of BDIassociated biliary strictures between July 2010 and July 2013. Results: The 10 patients included 6 women (60%) ranging in age from 26 to 64 years with a mean of 48.6 years. They were patients who failed in repeated conservative, interventional, endoscopic therapies in other hospitals. The interval between the initial operation causing BDI and this operation in our hospital was less than 3 months in 2 patients, less than 6 months in 2 patients, and more than a year in 3 patients. According to the Strasberg classification of BDI, there were 3 cases of type E2, 1 case of type E3, 6 cases of type E4, one patient with type E2 also had right hepatic duct injury besides common bile duct injury. All the 10 patients received biliary reconstruction and RYHJ based on their bile duct conditions. The non-traumatic technique was used in all cases, knowing that the diameter of the bile duct reconstructed was about 1.5 to 3cm. Two patients received segment I hepatectomy; 3 patients received biliary supporting tube placement during operation, which was removed 6 months after operation; and 3 patients received reconstruction of the hepaticojejunostomy anastomosis. All patients recovered well after a mean length of postoperative hospital stay of 9.2 days (range 7 to 13 days). By July 2013, the patients has been followed up for a mean of 19.9 months (range 4 to 36 months), during which no incisional complication, hemorrhage, bile leak, biliary re-stricture, acute pancreatitis, acute cholangitis, or cystic artery pseudoaneurysm occurred in any patients. The level of serum total bilirubin and conjugated bilirubin remained within the normal range. Conclusions: According to the Strasberg classification and the bile duct condition, appropriate biliary reconstruction and RYHJ for BDI-related biliary strictures can bring good outcomes.

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Section: Liu H Et Al Int Surg J 2015 May;2(2):179-186mentioning

confidence: 99%

Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

et al. 2015

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“…Long term prognosis is poor and there is a higher probability of bile colonization and cholangitis [16] .…”

Section: Strasberg B Injurymentioning

confidence: 99%

“…Although a Roux en Y hepatojejunostomy has been used in every single case, the operative technique has evolved greatly. At the beginning of our experience, an end to side anastomosis with a transanastomotic stent was used for E1-E3 injuries [16] . In cases with E-4 or E-5 injuries, a porto enterostomy was done with transhepatic stents placed through the intestinal lumen.…”

Section: Institutional Experiencementioning

confidence: 99%

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Classification and management of bile duct injuries

Mercado¹

2011

WJGS

Self Cite

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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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“…The disadvantage of biliary drainage is a higher risk of postoperative complications [62] . Mercado et al [63] Jabłońska B et al . Iatrogenic bile duct injuries recommend using transanastomotic stents when there is a thin bile duct less than 4 mm in diameter, and when there is inflammation within the ductal anastomosed edges which makes proper healing of the anastomosis questionable.…”

Section: Surgical Reconstructionsmentioning

confidence: 99%

Iatrogenic bile duct injuries: Etiology, diagnosis and management

Jabłońska¹,

Lampe²

2009

WJG

122

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Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Rouxen-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is endto-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

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To Stent or Not to Stent Bilioenteric Anastomosis After Iatrogenic Injury

Cited by 70 publications

References 14 publications

Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

Classification and management of bile duct injuries

Iatrogenic bile duct injuries: Etiology, diagnosis and management

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