To stent or not to stent bilioenteric anastomosis after iatrogenic injury: a dilemma not answered?
BACKGROUND
Bile duct injury is a complex and serious complication whose frequency has not diminished. A bilidigestive anastomosis (Roux-en-Y hepaticojejunostomy) is usually needed after complex injuries. Placement of an anastomotic stent is a matter of debate and to our knowledge there is no study that compares the results between stenting and not stenting the anastomosis.


METHODS
A retrospective review of medical records of patients operated on for biliary reconstruction after iatrogenic injury.


METHODS
Tertiary care academic university hospital.


METHODS
A comparative study was performed of patients operated on between 1995 and 1999, who were referred to our hospital for acute or elective reconstruction of the biliary tract following iatrogenic injury. All patients underwent Roux-en-Y hepaticojejunostomy. The patients were divided into 2 groups: those who underwent Roux-en-Y hepaticojejunostomy with a transanastomotic stent and those who underwent Roux-en-Y hepaticojejunostomy without a transanastomotic stent.


METHODS
Operative mortality, anastomotic dysfunction, biliary fistula, reoperations, postoperative complications, postoperative liver function tests.


RESULTS
Sixty-three patients with high and complex biliary injuries (Bismuth type III, IV; Strasberg D, E). Thirty-seven cases had reconstruction with the placement of a transanastomotic stent and 26 did not have a stent placed. No operative mortality was observed. The postoperative outcomes of both groups were compared and no differences found. Good results were observed in more than 80% of the patients. Reoperations were more frequent in the nonstented group (15% vs. 5%) and complications were more frequent in the stented group (16% vs. 7%).


CONCLUSIONS
Good results are obtained with a Roux-en-Y hepaticojejunostomy after complex injuries. The use of transanastomotic stents has to be selective according to the individual characteristics of each patient and the experience of each surgeon. We recommend their use when unhealthy (ie, ischemic, scarred) and small ducts (<4 mm) are found.
Mercado
Miguel Angel
MA
Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, 14000 México, DF. mercadiazma@yahoo.com
Chan
Carlos
C
Orozco
Héctor
H
Cano-Gutiérrez
Gumaro
G
Chaparro
Juan Manuel
JM
Galindo
Erick
E
Vilatobá
Mario
M
Samaniego-Arvizu
Gilberto
G
D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000293:injuries*; D016022:Case-Control Studies; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007582:Jejunostomy; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors