Abstract
Background
Roux-en-Y anastomosis is the standard of care for biliary reconstruction. Yet, a direct bilio-biliary anastomosis preserves the normal sphincter mechanism and endoscopic access to the biliary tree for diagnostic and therapeutic purposes. Duct-to-duct biliary reconstruction is widely used in liver transplantation. The objective of this study was to analyze the feasibility and results of duct-to-duct biliary reconstruction in the setting of complex hepatic resection with limited biliary confluence involvement.
Methods
We identified patients from our prospectively maintained database that underwent major hepatic resection and bile duct resection with a concomitant direct duct-to-duct biliary anastomosis. Postoperative oncological and functional biliary outcomes were analyzed.
Results
Ten patients were studied. In 9 cases, a biliary stent was left in place to decompress the anastomosis. Two patients developed a biliary fistula: one resolved spontaneously and the other required percutaneous drainage and an endoscopic biliary stent. This latter patient (the only nonstented patient) also developed a biliary stricture that was treated endoscopically. With a mean follow-up of 22 months, no other biliary-related complications were recorded. No patients had a recurrence at the biliary reconstruction site only. In the setting of multifocal hepatic recurrence presenting with jaundice, two patients were palliated by interventional endoscopy.
Conclusions
For hepatectomy requiring a short resection of the bile duct or for high bile duct injury during complex hepatectomy, a tension-free, well-vascularized duct-to-duct reconstruction over a stent is a suitable option that offers good oncological clearance of the bile duct and satisfactory functional results.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
De Castro S, Kuhlmann K, Busch O et al (2005) Incidence and management of biliary leakage after hepaticojejunostomy. J Gastrointest Surg 9:1163–1173
Antolovic D, Koch M, Galindo L et al (2007) Hepaticojejunostomy—analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg 11(5):555–561
Nagino M, Nishio H, Ebata Y et al (2007) Intrahepatic cholangiojejunostomy following hepatobiliary resection. Br J Surg 94:70–77
Ferrero A, Russolillo N, Viganò L et al (2008) Safety of conservative management of bile leakage after hepatectomy with biliary reconstruction. J Gastrointest Surg 12(12):2204–2211
Bismuth H, Franco D, Corlette MB et al (1978) Long term results of Roux-en Y hepaticojejunostomy. Surg Gynecol Obstet 146(2):161–167
Liu CL, Lo CM, Chan SC et al (2004) Safety of duct-to-duct biliary reconstruction in right-lobe live-donor liver transplantation without biliary drainage. Transplantation 77:726–732
Hashimoto T, Kokudo N, Hasegawa K et al (2007) Reappraisal of duct-to-duct biliary reconstruction in hepatic resection for liver tumors. Am J Surg 194(3):283–287
Endo I, Shimada H, Takeda K et al (2007) Successful duct-to-duct biliary reconstruction after right hemihepatectomy. Operative planning using virtual 3D reconstructed images. J Gastrointest Surg 11(5):666–670
Strasberg SM, Belghiti J, Clavien PA et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2:333–339
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Dulundu E, Sugawara Y, Sano K et al (2004) Duct-to-duct biliary reconstruction in adult living-donor liver transplantation. Transplantation 78(4):574–579
Kasahara M, Egawa H, Takada Y et al (2006) Biliary reconstruction in right lobe living-donor liver transplantation: comparison of different techniques in 321 recipients. Ann Surg 243(4):559–566
Lillemoe KD, Pitt HA, Cameron JL (1990) Postoperative bile duct strictures. Surg Clin North Am 70:1355–1380
Rossi RL, Tsao JI (1994) Biliary reconstruction. Surg Clin North Am 74(4):825–841
Vallera RA, Cotton PB, Clavien PA (1995) Biliary reconstruction for liver transplantation and management of biliary complications: overview and survey of current practices in the United States. Liver Transpl Surg 1:143–152
Gondolesi GE, Varotti G, Florman SS et al (2004) Biliary complications in 96 consecutive right lobe living donor transplant recipients. Transplantation 77:1842–1848
Kyoden Y, Tamura S, Sugawara Y et al (2010) Incidence and management of biliary complications after adult-to-adult living donor liver transplantation. Clin Transplant 24(4):535–542
Tsujino T, Isayama H, Sugawara Y et al (2006) Endoscopic management of biliary complications after adult living donor liver transplantation. Am J Gastroenterol 101(10):2230–2236
Scatton O, Meunier B, Cherqui D et al (2001) Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Ann Surg 233(3):432–437
Disclosure
The authors have no conflicts of interest to declare, and this research was unfunded and is not based on a previous communication.
Author information
Authors and Affiliations
Corresponding author
Additional information
R. Memeo and A. Belli contributed equally to this work.
Rights and permissions
About this article
Cite this article
Memeo, R., Belli, A., Kluger, M.D. et al. Duct-to-Duct Biliary Reconstruction During Complex Hepatectomy: A Useful Technique in Selected Cases. World J Surg 36, 129–135 (2012). https://doi.org/10.1007/s00268-011-1318-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-011-1318-x