title: Successful reconstruction of segmental or subsegmental bile ducts after resection of hilar bile ducts: short- and long-term results.
abstract: OBJECTIVE
  Biliodigestive anastomoses to small bile ducts after extensive liver resection or central bile duct remain difficult. The inherent problems associated with this particular procedure have not been widely discussed. In order to demonstrate that reconstruction of segmental or subsegmental bile ducts with mucosa-to-mucosa alignment using transanastomotic stents can reduce morbidity associated with the procedure, we have reviewed our experience with small biliodigestive anastomosis after liver resection.
  
  
  METHODS
  Thirteen patients were operated on from 1995 to 1997. Twelve had malignant diagnoses. A comprehensive standardized technique included the use of short or trans-intestinal trans-anastomotic stents and single layer interrupted absorbable sutures with mucosa-to-mucosa alignment. In the patients, in-hospital morbidity and mortality with focus on bile leaks and long-term signs of cholangitis and stricture formation were investigated with a median observation period of 42 months.
  
  
  RESULTS
  Eleven underwent extensive liver resections and two had complicated central resections including the bile duct confluence. The procedures included 40 transected bile ducts and 32 anastomoses to the jejunum. One patient died as a result of rupture of a splenic arterial aneurysm caused by a pancreatic pseudocyst. Other complications which occurred in seven patients were intra-abdominal fluid collection (n=5), wound infection (n=1), minor bile leakage from the liver cut surface (n=1), and pleural effusion (n=4). Postoperatively four patients, who had local recurrence with jaundice, showed cholangitis, whereas the remaining nine patients showed no signs of cholangitis.
  
  
  CONCLUSIONS
  Our technique for reconstructing small bile ducts with mucosa-to-mucosa alignment is considered adequate from the viewpoint of short- and long-term results.
authors.affiliation: Department of Surgery, Divisions of Hepato-Biliary-Pancreatic and Transplantation Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Karl
authors.initials: K
authors.lastname: Sondenaa
authors.forename: Keiiehi
authors.initials: K
authors.lastname: Kubota
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002761:Cholangitis / Q000209:etiology; D002780:Cholestasis, Intrahepatic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D007582:Jejunostomy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D015607:Stents