“Sideways”: Results of Repair of Biliary Injuries Using a Policy of Side-To-Side Hepatico-Jejunostomy

Abstract

HJ using side-to-side anastomosis has theoretical advantages and is usually possible. In some high right-sided injuries it could not be achieved. 95% excellent anastomotic function without intervention attests to the benefit of the method, especially as postoperative stenting >3 months was considered to be a "poor" result.

Classification and management of bile duct injuries

“…Winslow and Strasberg have recently stated that technical aspects of repair are essential for early and long term success [22] . If the repair is done in well vascularized ducts, is done without tension and with the largest diameter possible (achieved with the anterior opening of the duct), with epithelium to mucosa apposition using sutures that produce minimum reaction and complete biliary tree drainage, good long term results can be achieved.…”

“…Based on Strasberg's definition, some cases were repaired at the index operation (when the injury occurred, early primary repair), other cases with delayed primary repair (6 wk or more after the injury) and, in the great majority of cases (more than 90%), secondary repairs (patients who had a prior attempt of reconstruction) [22] . At the beginning of our experience, the Bismuth classification was used [10] .…”

Untitled

“…Hepp-Couinaud technique for accessing the left hepatic duct under the base of the quadratus lobe enables repair of high lesions, performing a bypass with reliable results. A side-to-side HJA, performed through a longitudinal incision of the left hepatic duct, produces a large anastomosis, minimizes the dissection behind the biliary tract and reduces the risk of excessive devascularization of liver ducts (Winslow, et al, 2009;Bachellier, et al, 2001). …”

Management of post-cholecystectomy bile duct injury:Review

“…It is not necessary to dissect and identify the distal bile duct or to resect the strictured segment (unless there is a suspicion of a malignant stricture), as it entails a potential risk for injury to the portal vein and hepatic artery. A side-toside hepaticojejunostomy made by a longitudinal incision of extrahepatic left hepatic duct produces a wide anastomosis, minimizes dissection behind the biliary ducts, and decreases the risk of devascularization of the ducts [26,27]. 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].…”