title: Biliary duct injury: partial segment IV resection for intrahepatic reconstruction of biliary lesions.
abstract: A technique for intrahepatic reconstruction of the biliary tree after complex high injuries is described. The fundament of the procedure is the removal of a wedge of segment IV at the level of the hilar plate. When the hilar plate is reached and no adequate exposure of the ducts can be obtained, removing a 1 x 1-in wedge of segment IV between the gallbladder bed and the round ligament exposes the left and right ducts. An anteroposterior view of the plate is obtained instead of a caudocephalic dissection, exposing healthy, nonscarred ducts for reconstruction. We have used this approach in 22 patients, and adequate exposure of the ducts has been obtained, with a high success rate of patency of the anastomosis at a mean follow-up of 3 years. Twenty patients have a patent anastomosis, with a good quality of life and no restenosis.
authors.affiliation: Department of Surgery, National Institute of Nutrition, Salvador Zubirán, Tlalpan, Mexico.
authors.forename: M A
authors.initials: MA
authors.lastname: Mercado
authors.forename: H
authors.initials: H
authors.lastname: Orozco
authors.forename: L
authors.initials: L
authors.lastname: de la Garza
authors.forename: L M
authors.initials: LM
authors.lastname: López-Martínez
authors.forename: A
authors.initials: A
authors.lastname: Contreras
authors.forename: E
authors.initials: E
authors.lastname: Guillén-Navarro
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged