title: [Transhepatic transanastomotic stents for bile duct injuries. Long-term evolution].
abstract: BACKGROUND
  With loss of continuity of the bile ducts after injury, surgery is the only feasible treatment option. Roux-en-Y hepatojejunostomy is the best choice. The use of transhepatic and transanastomotic tubes is still controversial. We evaluated patients who were operated on in which a transhepatic, transanastomotic tube was used because the characteristics of the ducts were inadequate.
  
  
  METHODS
  We conducted a retrospective, descriptive study between January 1995 and December 2006 for patients with iatrogenic bile duct injuries with a Roux-en-Y hepatojejunostomy and with placement of a transhepatic and transanastomotic tube. Postoperative evolution was analyzed and postoperative cholangitis was considered as failure.
  
  
  RESULTS
  We analyzed 74 patients: 66 patients had one tube, five patients had two tubes and three patients had only one but in the right duct. Mean age of patients was 37 years. Twenty portoenterostomies were done. The tube was removed in 55 patients and 11 continued with the tube, having periodic changes with internal-external biliary drainage. In 21% of the cases, a new intervention (either radiological or surgical) was needed. An adequate quality of life was reported by 64.86% of patients.
  
  
  CONCLUSIONS
  Anatomic and structural characteristics are unique for each patient. Use of a tube in the reconstructions of bile duct injuries is limited by the surgeon's experience. Characteristics of the ducts are most important. Therefore, selective use is indicated.
authors.affiliation: Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico. mercadiazma@yahoo.com
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Mercado-Díaz
authors.forename: Rebeca
authors.initials: R
authors.lastname: Ramírez-Morales
authors.forename: Mario Arturo
authors.initials: MA
authors.lastname: Medinilla-Cruz
authors.forename: Fernando
authors.initials: F
authors.lastname: Poucel-Sánchez Medal
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors