title: Techniques of biliary reconstruction following bile duct resection (with video).
abstract: In several clinical situations, including resection of malignant or benign biliary lesions, reconstruction of the biliary system using the Roux-en-Y jejunum limb has been adopted as the standard procedure. The basic technique and the procedural knowledge essential for most gastroenterological surgeons are described in this article, along with a video supplement. Low complication rates involving anastomotic insufficiency or stricture can be achieved by using proper surgical techniques, even following small bile duct reconstruction. Using the ropeway method to stabilize the bile duct and jejunal limb allows precise mucosa-to-mucosa anastomosis with interrupted sutures of the posterior row of the anastomosis. Placement of a transanastomotic stent tube is the second step. The final step involves suturing the anterior row of the anastomosis. In contrast to the lower extrahepatic bile duct, the wall of the hilar or intrahepatic bile duct can be recognized within the fibrous connective tissue in the Glissonean pedicle. The portal side of the duct should be selected for the posterior wall during anastomosis owing to its thickness. Meticulous inspection to avoid overlooking small bile ducts could decrease the chance of postoperative intractable bile leakage. In reconstruction of small or fragile branches, a transanastomotic stent tube could work as an anchor for the anastomosis.
authors.affiliation: Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-8638, Japan. satto@med.hokudai.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Joe
authors.initials: J
authors.lastname: Matsumoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kato
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D001660:Biliary Tract Diseases / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D015607:Stents
references.citation: Arch Surg. 2002 Aug;137(8):889-93; discussion 893-4
references.pmid: 12146986
references.citation: Ann Surg. 1996 Aug;224(2):162-7
references.pmid: 8757379
references.citation: Endoscopy. 2001 May;33(5):409-15
references.pmid: 11396758
references.citation: Langenbecks Arch Surg. 2002 Jul;387(3-4):188-9
references.pmid: 12172866
references.citation: J Gastrointest Surg. 2005 Jan;9(1):109-14
references.pmid: 15623451
references.citation: Langenbecks Arch Surg. 2011 Feb;396(2):209-15
references.pmid: 21058040
references.citation: Ann Surg. 2005 May;241(5):786-92; discussion 793-5
references.pmid: 15849514
references.citation: Mod Pathol. 2008 Jul;21(7):807-16
references.pmid: 18425077
references.citation: Hepatogastroenterology. 2004 Sep-Oct;51(59):1278-81
references.pmid: 15362732
references.citation: Surg Endosc. 2011 Aug;25(8):2526-35
references.pmid: 21359896
references.citation: Ann Surg Oncol. 2008 Jul;15(7):1871-9
references.pmid: 18454297
references.citation: J Gastrointest Surg. 2007 Mar;11(3):296-302
references.pmid: 17458601
references.citation: Clin Transplant. 2009 Jun-Jul;23(3):361-7
references.pmid: 19191813
references.citation: Br J Surg. 2007 Jan;94(1):70-7
references.pmid: 17058317
references.citation: J Gastroenterol Hepatol. 2002 Jul;17(7):807-10
references.pmid: 12121514
references.citation: J Hepatobiliary Pancreat Surg. 2007;14(5):429-33
references.pmid: 17909709
references.citation: Am Surg. 1998 Oct;64(10):917-20
references.pmid: 9764691
references.citation: World J Surg. 2001 Oct;25(10):1284-8
references.pmid: 11596891
references.citation: J Hepatobiliary Pancreat Sci. 2010 Jul;17(4):455-62
references.pmid: 19820891
references.citation: J Gastrointest Surg. 2008 Dec;12(12):2204-11
references.pmid: 18642049
references.citation: Surg Clin North Am. 1994 Aug;74(4):825-41; discussion 843-4
references.pmid: 8047944
references.citation: Arch Surg. 2004 Oct;139(10):1050-4
references.pmid: 15492141
references.citation: J Gastrointest Surg. 2007 May;11(5):555-61
references.pmid: 17394045
references.citation: Pediatr Surg Int. 2005 Jan;21(1):5-7
references.pmid: 15372285