Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury
Keywords:
Reconstruction, Roux-en-Y hepaticojejunostomy, Biliay strictures, Bile duct injuryAbstract
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 BDI-associated 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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References
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