Modified method of hepatic portal choledochoplasty to treat benign strictures of hilar biliary ducts.
OBJECTIVE
Roux-en-Y hepaticojejunostomy (RYHJ) is usually used to treat benign strictures of hilar bile ducts. However, RYHJ might also induce ascending cholangitis and recurrent hepatolithiasis. The present study aims to introduce a modified hepatic portal choledochoplasty with a pedicled graft of gallbladder (HPC) to treat this disease.


METHODS
One hundred and forty-nine patients, who had undergone HPC or RYHJ from January 1997 to January 2006 in our institutions, were included in this study, and the clinical data were retrospectively collected and analyzed.


RESULTS
The incidences of perioperative bile leakage and inflammatory ileus in patients treated with HPC were slightly lower than RYHJ without significant difference (1.89% vs 2.08% and 3.77% vs 5.21%, both P > 0.05). However, in a long-term follow up, patients treated with HPC had significantly lower incidences of cholangitis and recurrent hepatolithiasis (5.66% and 3.77%, respectively) than those treated with RYHJ (cholangitis, 21.88%; hepatolithiasis, 16.67%; both P < 0.05).


CONCLUSIONS
Compared to RYHJ, HPC is a safer and more efficient method to treat benign strictures of hilar biliary ducts. It preserves the sphincter of Oddi and normal biliary duct pressure, thus avoiding bile reflux into the bile duct.
Mi
Yuetang
Y
Department of General Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, China. Peter.witters@gmail.com
Li
Rui
R
Xu
Kesen
K
Li
Shikuan
S
Wang
Peige
P
Wu
Liqun
L
Mi
Haiyan
H
Yang
Guangyun
G
Zhang
Zhaoyang
Z
Niu
Jun
J
Jiang
Hongchi
H
Qiao
Haiquan
H
Sun
Xueying
X
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001660:Biliary Tract Diseases / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011171:Portoenterostomy, Hepatic; D012189:Retrospective Studies; D013524:Surgical Flaps