"Sideways": results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy.
BACKGROUND
The Hepp-Couinaud technique describes side-to-side HJ to the main left hepatic duct but a side-to-side approach is not consistently used when repairing other ducts. Compared with end-to-side repairs, side-to-side anastomoses require less dissection, theoretically preserving blood supply to the bile ducts, and usually permit wider anastomoses.


METHODS
We report the treatment results of 113 consecutive biliary injuries, with intention to perform side-to side anastomosis in all.


RESULTS
113 biliary injuries, 109 associated with cholecystectomy, were treated from 1992-2006. Injury types were B (7 patients, 6%); C (11 patients, 10%); E1 (8 patients, 7%); E2 (37 patients, 33%); E3 (20 patients, 18%); E4 (24 patients, 21%); E5 (6 patients, 5%). 19% of repairs were early (within 1 week after cholecystectomy), 58% were delayed (at least 6 weeks after cholecystectomy), and 22% were reoperations for recurrent strictures. In 92% of cases, side-to-side repair was accomplished. 23/113 (20%) developed postoperative complications, with one postoperative death. Mean follow-up was 4.9 years. Excellent anastomotic function was achieved in 107/112 (95%). "Poor" anastomotic results occurred in 5 patients: 2 patients with E4 injuries had postoperative anastomotic stenting >3 months, and 3 developed strictures requiring percutaneous dilation. There have been no reoperations for biliary strictures.


CONCLUSIONS
HJ using side-to-side anastomosis has theoretical advantages and is usually possible. In some high right-sided injuries it could not be achieved. 95% excellent anastomotic function without intervention attests to the benefit of the method, especially as postoperative stenting >3 months was considered to be a "poor" result.
Winslow
Emily R
ER
Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, Missouri 63110, USA.
Fialkowski
Elizabeth A
EA
Linehan
David C
DC
Hawkins
William G
WG
Picus
Daniel D
DD
Strasberg
Steven M
SM
D000007:Abdominal Injuries / Q000150:complications; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D002763:Cholecystectomy / Q000009:adverse effects*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D012189:Retrospective Studies