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.
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