Hepaticojejunostomy with transhepatic intubation. A technique for very high strictures of the hepatic ducts

Smith, Rodney

doi:10.1002/bjs.1800510307

Cited by 93 publications

(14 citation statements)

References 2 publications

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“…The repair of hilar IBDI requires special surgical techniques. In the past, the so-called "mucosal graft technique" described by Smith in the 1960s was performed [57,58] . This reconstruction involves creating a mucosal dome of jejunum (by removing a seromuscular patch) near the end of the Roux-en-Y loop through which a straight rubber tube is passed via hepatic ducts and through the liver parenchyma.…”

Section: Surgical Reconstructionsmentioning

confidence: 99%

“…Therefore, currently, not Smith but the Blumgart-Hepp technique is used in reconstruction of hilar IBDI. In this technique, the dorsal surface of the left hepatic duct is placed parallel to the quadrate hepatic lobe; dissection and opening of the left hepatic duct longitudinally allows creation of a wide anastomosis of 1-3 cm in diameter [11,25,[57][58][59][60] .…”

Section: Surgical Reconstructionsmentioning

confidence: 99%

“…This drainage type is used in high intrahilar biliary-enteric anastomosis. In the past, it was used in the Smith "mucosal graft technique" [54,[58][59][60] . The use and duration of biliary drainage is still controversial.…”

Section: Surgical Reconstructionsmentioning

confidence: 99%

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Iatrogenic bile duct injuries: Etiology, diagnosis and management

Jabłońska¹,

Lampe²

2009

WJG

124

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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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Section: Surgical Reconstructionsmentioning

confidence: 99%

Section: Surgical Reconstructionsmentioning

confidence: 99%

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Iatrogenic bile duct injuries: Etiology, diagnosis and management

Jabłońska¹,

Lampe²

2009

WJG

124

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“…We believe that use of the transhepatic tube, as originally described by Smith [7], is necessary for drawing the mucosal graft through the scar tissue under the liver to bring it in contact with the epithelium of the bile ducts. It also provides access to the biliary tree for daily irrigations to prevent sludge formation.…”

Section: Discussionmentioning

confidence: 99%

“…These risk factors are intraoperative bleeding, jaundice prior to surgery warranting common bile duct exploration, and poor intraoperative assistance. The results of hepaticojejunostomy with and without sutureless jejunal mucosal grafting are also identified [6,7].…”

Section: Ts Malatani Damage To the Bile Ducts Atmentioning

confidence: 99%

Damage to the Bile Ducts at Cholecystectomy

Malatani

1991

Ann Saudi Med

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Six patients who incurred iatrogenic injury to the extrahepatic bile duct following elective cholecystectomy are described. All cases were diagnosed three weeks to one year after operation. In none of the patients was an operative cholangiogram performed during the original cholecystectomy to detect congenital biliary tree anomalies or obstruction. Possible risk factors contributing to such injuries were intraoperative bleeding, common bile duct exploration in patients with obstructive jaundice, and poor surgical assistance. Obesity was not found to be of significance since all six patients were thin. Iatrogenic bile duct injuries are best managed at the time of injury during the primary operation. When recognized later in the postoperative period, choledocho/hepaticojejunostomy gives the best result. Cholecystectomy. 1991; 11(4): 396-401 Cholecystectomy is the most commonly performed major abdominal operation in Saudi Arabia [1]. Accidental injury to the biliary tract is an infrequent complication of this operation, but when it occurs, it is always very serious and associated with some mortality and high morbidity. It has been called "the most catastrophic complication of a straightforward cholecystectomy" [2]. The incidence of such injuries ranges from 0.2 to 0.9% in patients undergoing cholecystectomy [3][4][5]. TS Malatani, Damage to The Bile Ducts atThis paper attempts to identify some of the possible risk factors in order to help surgeons avoid accidental injury to the biliary tree at cholecystectomy. These risk factors are intraoperative bleeding, jaundice prior to surgery warranting common bile duct exploration, and poor intraoperative assistance. The results of hepaticojejunostomy with and without sutureless jejunal mucosal grafting are also identified [6,7].During a follow-up period of 15 to 28 months (mean, 20 months), recurrent symptoms and evidence of biliary strictures were recorded. Patients, Methods, and ResultsSince February 1988, six patients had been referred to Assir Central Hospital with iatrogenic biliary tract injury following elective cholecystectomy performed in different district general hospitals of the Assir region. All cases were diagnosed in the postoperative period, three weeks to one year following cholecystectomy. All original operations were performed by a consultant surgeon with poor intraoperative assistance. In none of the patients was an operative cholangiogram performed.Liver function tests were assayed on the Hitachi 704 autoanalyzer. Alkaline phosphatase was assayed using the p-nitrophenyl phosphate method (normal range at 37°C, 98-279 U/L) adult. Bilirubin was assayed by the Jendrassik method (normal value, < 17 μmol/L for the total, < 3.7 μmol/L for the direct).Details of the six patients are as follows:

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Percutaneous Decompression of Benign and Malignant Biliary Obstruction

Pollock¹

1979

Arch Surg

101

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Hepaticojejunostomy with transhepatic intubation. A technique for very high strictures of the hepatic ducts

Cited by 93 publications

References 2 publications

Iatrogenic bile duct injuries: Etiology, diagnosis and management

Iatrogenic bile duct injuries: Etiology, diagnosis and management

Damage to the Bile Ducts at Cholecystectomy

Percutaneous Decompression of Benign and Malignant Biliary Obstruction

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