Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation

Li, Suolin; Wang, Wenbo; Zhou, Yu; Xu, Weili

doi:10.1007/s00383-014-3501-2

Cited by 26 publications

(11 citation statements)

References 14 publications

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“…Various management options have been proposed for the anastomosis in a CC with a narrow hilar duct, such as hilar ductoplasty with a wide hepaticojejunostomy [23–25], a modified Kasai’s procedure [8], and partial hepatectomy with a wide hepaticojejunostomy [19, 26]. Hilar ductoplasty with hepaticojejunostomy resulted in satisfactory outcomes for type Ia CCs based on a modest sample size after a minimum of 2 years of follow-up, and a reduction of anastomotic strictures was observed compared with conventional hepaticojejunostomy [27].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct

Chang

Xiong

et al. 2019

Surg Endosc

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Background Complete cyst excision with Roux-en-Y hepaticojejunostomy is the standard procedure for choledochal cysts (CCs). In recent years, neonates have been increasingly diagnosed with CCs prenatally. Earlier treatment has been recommended to avoid complications. For type IVa malformation without extensive intrahepatic bile duct dilatation, laparoscopic hepaticojejunostomy is technically challenging, and anastomotic stricture is a concern. Therefore, we propose laparoscopic synthetical techniques—laparoscopic excision of cyst and ductoplasty plus widened portoenterostomy to avoid stricture in CCs with a narrow hilar duct. Methods An anastomosis was created around the transected end of the common bile duct in 12 minipigs (Group A), and another 12 minipigs (Group B) received conventional cholangiojejunostomy. Anastomotic diameter measurements and cholangiography were conducted at different times. Histological findings of inflammation and scarring were compared. The expression levels of TGF-β1 and type I collagen were detected by real-time quantitative PCR. Between January 2012 and January 2016, laparoscopic excision of cyst and ductoplasty plus widened portoenterostomy were performed on 29 children with confirmed CCs with a narrow portal bile duct who were followed up for 12–48 months. Results Group A survived well without obstruction. Slight inflammation and fibrotic tissue were confined to the bile duct periphery. In Group B, five pigs developed stricture. Severe inflammation and diffuse fibrosis affected the whole layer of the anastomosis. Fibrotic biomarkers were significantly higher postoperatively in Group B. Clinically, 29 patients exhibited satisfactory outcomes. No anastomotic stricture has been observed to date. Conclusions Laparoscopic synthetical techniques may be a superior option to prevent anastomotic stricture in treating CCs with a narrow portal bile duct. Electronic supplementary material The online version of this article (10.1007/s00464-018-06635-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct

Chang

Xiong

et al. 2019

Surg Endosc

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“…One of the key points in the surgical management of ChC is performing of hepatico-enterortomy since most common complications after surgery for ChC such as bile leak or anastomotic stenosis (with subsequent cholangistis and biliary stones formation) were related to this anastomosis [1][2][3][4][5][6][7][8][9]. After open surgery for ChC, the rate of postoperative complications, especially anastomotic stricture requiring redo surgery, may be up to 10% [9].…”

Section: Discussionmentioning

confidence: 99%

“…These complications have been reported to be up to 10 % in different series for both open and laparoscopic approaches [1][2][3][4][5][6][7][8][9]. To avoid aforementioned complications, especially in cases of unfavorable biliary anatomy such as a very small common hepatic duct or presence of an aberrant duct, a hepatic ductoplasty (HDP) may be necessary [6][7][8][9][10]. Hepatic ductoplasty (HDP) is considered to be a technically demanding procedure and should be performed by surgeons with proficiency and experience [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…To avoid aforementioned complications, especially in cases of unfavorable biliary anatomy such as a very small common hepatic duct or presence of an aberrant duct, a hepatic ductoplasty (HDP) may be necessary [6][7][8][9][10]. Hepatic ductoplasty (HDP) is considered to be a technically demanding procedure and should be performed by surgeons with proficiency and experience [6][7][8]. Transumbilical laparoscopic single site surgery (TULESS) or SILS (single incision laparoscopic surgery) has been recently introduced to the management of childhood ChC with promising initial results and cosmetic advantages over the CLS [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Trans-Umbilical Laparo-Endoscopic Single Site Surgery with Hepatic Ductoplasty in Management of Childhood Choledochal Cyst: A Single Surgeon Experience with 46 Cases

Son

Duc

Van

2019

AJGH

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Aim: To present our techniques and results of trans-umbilical laparo-endoscopic single site surgery (TULESS) with hepatic ductoplasty in the management of childhood choledochal cyst (ChC). Methods: All ChC cases undergoing TULESS excision of ChC, ductoplasty and hepatico-jejunostomy by the same surgeon from October 2012 to October 2017 were reviewed. For TULESS, 3 trocars were placed at a single umbilical skin incision and conventional instruments were used.Results: 46 patients (35 girls, 11 boys) with hepatic ductoplasty were identified from total 237 patients with ChC undergoing TULESS by the same surgeon for the review period. The median age was 17 months. Ductoplasty for a small common hepatic duct (less than 5mm) was carried out in 38 patients and for the presence of an aberrant duct in 8 patients. The median operative time was 195 minutes. There was no intraoperative complication, no conversion to open surgery. Additional trocars (conversion to conventional laparoscopic surgery) were required in just the first case of aberrant duct. Postoperative bile leak was noted in one patient (2.2%), which was resolved with non-operative treatment. The median postoperative hospital stay was 5 days. At a median follow up of 36 months (range: 3 months to 60 months), one patient needed redo surgery for anastomotic stenosis; all other patients were in good health, with excellent postoperative cosmesis. Conclusion:TULESS with conventional instruments is feasible and safe for hepatic ductoplasty for childhood ChC with small common hepatic duct or aberrant duct.

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“…The bile duct was obtained by laparotomy. After trimming and dipping in heparin solution, 10 an oval patch measuring 15 Â 10 mm was used to reconstruct the PV, which was side clamped or cross-clamped. Roux-en-Ycholangio-jejunostomy was performed to anastomose the bile duct and jejunum.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Feasibility of bile duct as venous graft for venous reconstruction in pancreatic surgery: An animal experimental study

Fan

Dai

et al. 2020

Vascular

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Objective Pancreatic cancer is a kind of high malignant tumor with a poor prognosis. The aim is to determine whether the dilated bile duct can be used to reconstruct the vessels. Methods An animal model of jugular vein and portal vein reconstruction was established using the bile duct. A total of 20 landrace pigs were selected to undergo jugular vein reconstruction or portal vein reconstruction using the bile duct as a patch or bridge. The patency was evaluated by color Doppler, the reconstructed segments were removed and examined macroscopically and histologically at specified intervals, and the results were compared with synthetic vessels (IMPRA straight, 10s03-19). Results The lumen was patent, although a low level thrombosis was observed when jugular or portal vein patching was used. For bridging, stenosis of the lumen was observed, and necrosis appeared when the bile duct was used for bridging, indicating that it is feasible to reconstruct the jugular vein and portal vein with a bile duct patch. However, the bridge was not feasible possibly due to loss of blood supply, and consequent necrosis and fibrosis. Conclusion The bile duct is technically feasible, but the outcomes are unsatisfactory.

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Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation

Cited by 26 publications

References 14 publications

Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct

Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct

Trans-Umbilical Laparo-Endoscopic Single Site Surgery with Hepatic Ductoplasty in Management of Childhood Choledochal Cyst: A Single Surgeon Experience with 46 Cases

Feasibility of bile duct as venous graft for venous reconstruction in pancreatic surgery: An animal experimental study

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