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Ann Surg. 2009 Mar;249(3):426-34. doi: 10.1097/SLA.0b013e31819a6b2e.

"Sideways": results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy.

Author information

  • 1Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, Missouri 63110, USA.

Abstract

BACKGROUND:

The Hepp-Couinaud technique describes side-to-side HJ to the main left hepatic duct but a side-to-side approach is not consistently used when repairing other ducts. Compared with end-to-side repairs, side-to-side anastomoses require less dissection, theoretically preserving blood supply to the bile ducts, and usually permit wider anastomoses.

METHODS:

We report the treatment results of 113 consecutive biliary injuries, with intention to perform side-to side anastomosis in all.

RESULTS:

113 biliary injuries, 109 associated with cholecystectomy, were treated from 1992-2006. Injury types were B (7 patients, 6%); C (11 patients, 10%); E1 (8 patients, 7%); E2 (37 patients, 33%); E3 (20 patients, 18%); E4 (24 patients, 21%); E5 (6 patients, 5%). 19% of repairs were early (within 1 week after cholecystectomy), 58% were delayed (at least 6 weeks after cholecystectomy), and 22% were reoperations for recurrent strictures. In 92% of cases, side-to-side repair was accomplished. 23/113 (20%) developed postoperative complications, with one postoperative death. Mean follow-up was 4.9 years. Excellent anastomotic function was achieved in 107/112 (95%). "Poor" anastomotic results occurred in 5 patients: 2 patients with E4 injuries had postoperative anastomotic stenting >3 months, and 3 developed strictures requiring percutaneous dilation. There have been no reoperations for biliary strictures.

CONCLUSIONS:

HJ using side-to-side anastomosis has theoretical advantages and is usually possible. In some high right-sided injuries it could not be achieved. 95% excellent anastomotic function without intervention attests to the benefit of the method, especially as postoperative stenting >3 months was considered to be a "poor" result.

PMID:
19247030
[PubMed - indexed for MEDLINE]
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