International Journal of Gastroenterology
Volume 2, Issue 1, June 2018, Pages: 7-11
Received: Apr. 12, 2018;
Accepted: May 10, 2018;
Published: May 30, 2018
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Oscar Chapa-Azuela, General Hospital of México, Mexico City, México
Alejandro José Rosales, General Hospital of México, Mexico City, México
Carmen Roca-Vasquez, General Hospital of México, Mexico City, México
Brenda Arcos-Vera, Issemym Toluca Medical Center, Toluca, Mexico
Jorge Alberto Roldan-Garcia, General Hospital of México, Mexico City, México
Gustavo Alain Flores-Rangel, General Hospital of México, Mexico City, México
Introduction: Iatrogenic bile duct injuries (IBDI) with loss of confluence are understood as those where right and left hepatic ducts lose continuity with the common biliary tree. These represent 4% of all IBDI and are considered a very demanding surgical challenge. Study design: This is a series of case in a reference center during an eight-year period (2008 – 2016), where all patients with IBDI and loss of confluence submitted to any bilioenteric derivation procedure were included. Results: From a total of 11 cases, 10 of them (90.1%) were treated with double bilioenteric derivation and 1 (9%) with a neo-confluence. In 90.9% (n=10) of the patients a percutaneous catheter of biliary drainage was placed before the surgical procedure. Within a 34.5 months follow-up, the initial approach was successful in 54.5% (n=6), meanwhile accumulated achievement was 81.8% (n=9) considering dilatation and remodeling procedures. From this, 18.2% (n=2) are still with stenosis of derivation in a dilatation protocol with percutaneous catheter. Conclusions: Double hepatojejunostomy with transanastomotic stents and management of eventual stenosis with percutaneous dilatation as a first therapeutic intention results in a standardized practice that leads to reasonable results compared with other high volume centers.
Alejandro José Rosales,
Jorge Alberto Roldan-Garcia,
Gustavo Alain Flores-Rangel,
Bile Duct Injuries with Loss of Confluence, International Journal of Gastroenterology.
Vol. 2, No. 1,
2018, pp. 7-11.
Mercado M, Vilatoba M, Contreras A, Leal P, Cervantes E, Arriola J, et al. Iatrogenic bile duct injury with loss of confluence. World J Gastrointest Surg 2015; 7 (10):254-260.
Pickleman J, Marsan R, Borge M. Portoenterostomy. An Old Treatment for a New Disease. Arch Surg. 2000; 135:811-817.
Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW. Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg. 2004; 8:523–530.
Laurent A, Sauvanet A, Farges O, Watrin T, Rivkine E, Belghiti J. Major hepatectomy for the treatment of complex bile duct injury. Ann Surg. 2008; 248:77–83.
Gao Z, Li P, Chen F, Tan D. The Clinical Analysis of Bile Duct Injury during Laparoscopic Cholecystectomy Int Jour of Clin Med. 2015; 6:825-830.
Cui Y, Zhang H, Cui N, Li Z. Surgical treatment for benign biliary strictures: single-center experience on 64 cases. EXCLI Jour. 2012; 11:390-398.
B. Melton, MD, Keith D. Lillemoe, MD, John L. Cameron, MD, Patricia A. Sauter, CRNP, JoAnn Coleman, CRNP, and Charles J. Yeo, MD. Major Bile Duct Injuries Associated With Laparoscopic Cholecystectomy. Anns Surg. 2002; 235 (6):888-895.
Blumgart´s. Surgery of the Liver, Biliary Tract and Pancreas. 5ta ed, Vol 1, ed elsevier. 2012.
Strasberg SM, Picus DD, Drebin JA. Results of a new strategy for reconstruction of biliary injuries having an isolated right-sided component. J Gastrointest Surg. 2001; 5:266–274.
Perini M, Herman P, Montagnini A, Jukemura J, Coelho F, Kruger J, Bacchella T, Cecconello I. Liver resection fo the treatment of post. cholecystectomy biliary stricture with vascular injury. Wolrd Journal og Gastroenterology. 2015 21; 21 (7):2102-2107.
Strasberg S, Scott W, An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB. 2011; 13:1–14.
Perini M, Herman P, Montagnini A, Jukemura J, Coelho F, Kruger J, et al. Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury. World J Gastroenterol 2015; 21 (7):2102-2107.
Li J, Frilling A, Nadalin S, Broelsch C, Malago M. Timing and Risk Factors of Hepatectomy in the Management of Complications Following Laparoscopic Cholecystectomy. J Gastrointest Surg. 2012; 16:815–820.
Laurent A, Sauvanet A, Farges O, Watrin T, Rivkine E, Belghiti J. Major Hepatectomy for the Treatment of Complex Bile Duct Injury. Annal of Surg. 2008; 248 (1):77-83.
Santibañee E, Ardiles V, Pekolj J. Complex bile duct injuries: management. HPB 2008. 10; 4-12.
Nicolaj M. Stilling1, Claus Fristrup1, André Wettergren2, Arnas Ugianskis3, Jacob Nygaard4, Kathrine Holte2, Linda Bardram2, Mogens Sall3 & Michael B. Mortensen1. Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study. HPB 2015, 17, 394–400.
Kirks R, Barnes T, Lorimer P, Cochran A, Siddiqui I, Martinie J, Baker E, Iannitti D, Vrochides D. Comparing early and delayed repair of common bile duct injury to identify clinical drivers of outcome and morbidity. HPB 2016; 18:718-725.
Stewart L, Way L. Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB 2009:11; 516-522.
Mercado M, Arriola J, Dominguez I, Elnecavé A, Urencio M, Ramirez F, et al. Lesión iatrogénica de vía biliar con pérdida de confluencia: Opciones quirúrgicas. Cir Gen. 2010; 32 (3):160-166.
Jabłońska B, Lampe P. Iatrogenic bile duct injuries: Etiology, diagnosis and management. World J Gastroenterol. 2009; 15 (33):4097-4104.