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Outcome of hepaticojejunostomy without access loop for repair of iatrogenic bile duct injury at laparoscopic cholecystectomy
Author(s) -
Barrow Paul J.,
Siriwardena Ajith K.
Publication year - 2007
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-006-1174-5
Subject(s) - medicine , surgery , cholecystectomy , bile duct , concomitant , stage (stratigraphy) , percutaneous , roux en y anastomosis , stenosis , gastric bypass , paleontology , weight loss , biology , obesity
Background Purpose Roux‐en‐Y hepaticojejunostomy is the accepted treatment for transectional biliary injury at cholecystectomy. Many authors advocate leaving a long redundant jejunal access loop to facilitate subsequent access. Reasoning that percutaneous access can be achieved transhepatically in patients with stenosis, this study reports the outcome of a policy of biliary repair without the use of a jejunal access loop. Methods Eleven patients undergoing biliary reconstruction over a 5‐year period constituted the study population. Three (27%) were male, and the median (range) age at injury was 53 (26–75) years. Median delay from injury to repair was 2 (1–48) months. Bismuth stage was: stage I, 4; stage II, 5; and stage III, 2. Four patients had concomitant arterial injury. All underwent surgical repair by Roux‐en‐Y hepaticojejunostomy without an access loop. Results The median follow‐up was 13 (1–64) months. The principal postoperative complication was a hepatic abscess in one patient. There was one death during follow‐up, from acute myeloid leukemia. One patient (9%) with a type III injury presented with a symptomatic recurrent biliary stricture 6 months after repair, and was successfully managed by percutaneous biliary dilatation, using a combination of transhepatic and jejunal loop puncture. Conclusions Successful biliary reconstruction can be performed without a routine jejunal access loop.