[Treatment of cicatricial stenosis of the proximal common hepatic duct. Study of 11 cases].
Eleven patients with cicatricial stenosis in the junction area of hepatic ducts were evaluated. In all patients the injury occurred during cholescystectomy and no operative cholangiography was performed. In 3 patients the injury was recognized during the initial cholecistectomy. Ten patients had been operated on at least one time to correct the injury in other Services. Four cases had duct or peritoneal drainage. There was an attempt of reanastomosis in two cases. Five patients had a bilio-digestive anastomosis performed in variable occasions. Two patients were reoperated 5 times, one patient 3 times. The others were submitted to one or 2 reoperations. There were a period of 1 to 72 months between the injury and last reoperation. Jaundice was the most common presenting manifestation since it appeared in all patient except one. Five patients had biliary cirrhosis. Roux-en-Y hepaticojejunostomy was carried out in all cases after enlarging the biliar stoma by longitudinal section on the left hepatic duct and performing a termino-terminal anastomosis. The 10 or 12 caliber Kehr drain used was taken out after the control cholangiography, carried around the second postoperative week. Concerning the long term results, one patient died of recurrent cholangitis six months after the 6th reoperation and one patient 14 months after the 4th reoperation of liver failure. Both had biliary cirrhosis. Two patients, remained assymptomatic for 60 months and 3 patients for 24, 37 and 56 months. The importance of preventing this severe complication is stressed by the authors. Patients with such lesions need be referred to specialized centers where well trained surgeons are available. The technique herein presented seems us to be a good option.
Speranzini
M B
MB
Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo.
Mittelstaedt
W
W
Deutsch
C
C
Cunha
J C
JC
Waisberg
J
J
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001649:Bile Duct Diseases / Q000601:surgery*; D002758:Cholangiography; D002763:Cholecystectomy / Q000009:adverse effects*; D002764:Cholecystitis / Q000601:surgery; D005260:Female; D006500:Hepatic Duct, Common / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012086:Reoperation
Tratamento das estenoses cicatriciais da porção proximal do ducto hepático comum. Estudo de 11 casos.