Reliable reconstruction of the complex high-location bile duct injury: a novel hepaticojejunostomy

Abstract

BackgroundThis study aimed to propose a novel surgical reconstruction technique for complex high-location bile duct injury (CHBDI).MethodsThere were eight patients with CHBDI underwent the novel hepaticojejunostomy between Feb 2015 and Feb 2017. Seven patients underwent a primary operation and found CHBDI postoperatively in the inferior hospitals referred to our center. And four of them had received hepaticojejunostomy, but the results were not satisfying. One patient (No.8) with radiographically diagnosed hilar cholangiocarcinoma came to our center for surgical treatment and underwent the novel hepaticojejunostomy technique because CHBDI was found in operation. Perioperative and follow-up data of these patients were retrospectively reviewed.ResultsThe mean age was 47.6 ± 10.7 years, and there was four female. The mean range of time between the injury and the repair operation in our center was 6.3 ± 4.8 months. All repair operations using the novel hepaticojejunostomy technique in our center were successfully performed. No postoperative complications, including biliary fistula, restenosis, peritonitis, and postoperative cholangitis was observed. Besides, no evidence of biliary stenosis or biliary complications happened during the follow-up (median 28 months).ConclusionsThe novel hepaticojejunostomy is a reliable and convenient technique for surgical repair of multiple biliary ductal openings like CHBDI.

Outcomes of hepaticojejunostomy for post-cholecystectomy bile duct injury

“…Familiarity with the porta hepatis during donor and recipient operations and small duct-to-duct biliary anastomoses using 7/0 sutures may have been responsible for these outcomes. 33 – 35 …”

“…Familiarity with the porta hepatis during donor and recipient operations and small duct-to-duct biliary anastomoses using 7/0 sutures may have been responsible for these outcomes. [33][34][35] Liver resection is required in only 0.8% to 1.4% patients with complex vasculobiliary injury or proximal BDI. 12,17 A recent systematic review showed that only 67 patients underwent right hepatectomy for BDI.…”