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Duct-To-Duct Biliary Anastomosis with Removable Internal Biliary Stent During Major Hepatectomy Extended to the Biliary Confluence

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Journal of Gastrointestinal Surgery

Abstract

Background

Roux-en-Y hepaticojejunostomy (HJ) currently represents the gold standard after resection of the biliary confluence. This non-physiological reconstruction poses several problems such as repeated cholangitis or stricture without conventional endoscopic access. Our aim was to describe and to report both feasibility and results of duct-to-duct anastomosis with removable internal biliary drain (RIBS) as an alternative technique to the HJ after resection of the biliary confluence in patients undergoing major liver resection.

Methods

Between January 2014 and January 2018, all patients who underwent a major hepatectomy associated with resection of the biliary confluence and reconstruction by duct-to-duct biliary anastomosis with RIBS were retrospectively included. Patient demographics, tumor characteristics, pre- and postoperative outcomes, early and late biliary complications, endoscopic complications, and clinical follow-up were collected.

Results

Twelve patients were included. The operative time was 326 ± 45 min (range 240–380 min). There was no postoperative mortality. Only one patient experienced biliary anastomotic leakage treated exclusively by radiological and endoscopic drainage. Four patients had an asymptomatic stricture of the biliary anastomosis detected by endoscopic retrograde cholangiopancreatography (ERCP) during the extraction of the RIBS requiring iterative dilatation and replacement of the RIBS. Among 21 performed ERCP, no complications such as failure of RIBS extraction, duodenal perforation, bleeding after sphincterotomy, cholangitis, or pancreatitis were observed. After a mean and a median follow-up of respectively 15.0 ± 14.9 and 8.7 months (range 2.0–46.1 months), no cholangitis occurred.

Conclusion

Duct-to-duct biliary anastomosis with RIBS insertion after resection of the biliary confluence represents a feasible and safe alternative to the HJ.

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Acknowledgments

Dr. R. Brustia for the schematic drawing explaining the surgical procedure.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Maxime K. Collard, Jérôme Danion, Fabiano Perdigao & Olivier Scatton

  2. Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, AP-HP, 100, Boulevard du Général Leclerc, 92110, Clichy, France

    François Cauchy & Olivier Soubrane

  3. Department of Gastroenterology and Endoscopy, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France

    Sarah Leblanc & Frédéric Prat

  4. Paris-V Descartes University, Paris, France

    Frédéric Prat

  5. Paris-VII Diderot University, Paris, France

    Olivier Soubrane

  6. Sorbonne University, Paris, France

    Olivier Scatton

Authors
  1. Maxime K. Collard
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  2. Jérôme Danion
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  3. François Cauchy
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  4. Fabiano Perdigao
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  5. Sarah Leblanc
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  6. Frédéric Prat
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  7. Olivier Soubrane
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  8. Olivier Scatton
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Contributions

Study concept and design: M. Collard, J. Danion, F. Cauchy, O. Soubrane, O. Scatton. Data collection, analysis, and interpretation: M. Collard, F. Perdigao, S. Leblanc, F. Prat, O. Scatton. Writing: M. Collard, J. Danion, O. Scatton Critical revision: F. Cauchy, F. Perdigao, S. Leblanc, F. Prat, O. Soubrane. All authors approved the final version to be published. Each author is accountable for all aspects of the work.

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Correspondence to Olivier Scatton.

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Collard, M.K., Danion, J., Cauchy, F. et al. Duct-To-Duct Biliary Anastomosis with Removable Internal Biliary Stent During Major Hepatectomy Extended to the Biliary Confluence. J Gastrointest Surg 22, 2201–2208 (2018). https://doi.org/10.1007/s11605-018-3905-8

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  • DOI: https://doi.org/10.1007/s11605-018-3905-8

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