Intrahepatic Repair of Bile Duct Injuries. A Comparative Study

Abstract

An intrahepatic anastomosis requires finding nonscarred, nonischemic ducts, thus allowing a safe and high-quality anastomosis with significantly better results when compared to the low-level anastomosis group.

Biliary Complications Post Laparoscopic Cholecystectomy: Mechanism, Preventive Measures, and Approach to Management: A Review

“…The attempt to place a catheter into the injured nondilated proximal duct during the course of a laparoscopic cholecystectomy may, however, cause further injury to the CHD, particularly when performed by an inexperienced surgeon. Clipping of the divided duct is sometimes performed with intent to prevent bile leak and allow the injured duct to stricture resulting in the proximal duct dilatation which facilitates a hepaticojejunostomy [31]. This is rarely successful because in the majority of cases the clipped or ligated ducts sloughs, thus causing the inevitable bile leak and resulting in the injury becoming even more proximal.…”

“…This is rarely successful because in the majority of cases the clipped or ligated ducts sloughs, thus causing the inevitable bile leak and resulting in the injury becoming even more proximal. Moreover, the clip (or ligature) also interferes with the blood supply and causes ischaemic injury [31]. …”

Iatrogenic Bile Duct Injuries Following Laparoscopic Cholecystectomy: Myth or Reality? A Recent Literature Review from 2006 to 2011

“…The defunctionalised loop avoid intestinal reflux into the BT and prevents ascending cholangitis. The hepatoduodenal anastomosis has an increased anastomotic tension and reflux, and a higher rate of developing high debt biliary fistula (Mercado, 2008). Still controversial is the effectiveness and the duration of a transanastomotic tutor, and it depends on surgeon's experience and choice.…”

Management of post-cholecystectomy bile duct injury:Review

“…Other procedures, which may be very rarely required in complex strictures where the conventional approach has failed, include the intrahepatic hepaticojejunostomy described by Longmire and Sanford [28] and the Smith's mucosal graft [29]. In difficult strictures with confluence involvement, excision of the base of segment 4 to access the healthy, vascularized proximal duct to perform a tension-free intrahepatic anastomosis has yielded excellent results [30,31]. The use of transanastomotic stents remains controversial.…”