title: Cluster Hepaticojejunostomy Is a Useful Technique Enabling Secure Reconstruction of Severely Damaged Hilar Bile Ducts.
abstract: Secure reconstruction of multiple hepatic ducts severely damaged by tumor invasion or iatrogenic injury is very difficult. If percutaneous or endoscopic biliary stenting fails, one or more percutaneous transhepatic biliary drainage (PTBD) tubes must be maintained in place for the rest of the patient's life. To cope with such difficult situations, we present a surgical technique termed cluster hepaticojejunostomy (HJ), which can be coupled with palliative bile duct resection. The cluster HJ technique consisted of applying multiple internal biliary stents and a single wide porto-enterostomy to surrounding connective tissues. We present a preliminary study with six patients. Five perihilar cholangiocarcinoma patients undergoing palliative bile duct resection received this procedure. Follow-up PTBD tubogram and hepatobiliary scintigraphy were performed at 1-2 weeks after surgery, after which the PTBD tubes were removed. No patient showed surgical complications, and the 6-month patency rate of clustered HJ was 80%. Another patient with laparoscopic cholecystectomy-associated major bile duct injury showed no biliary complications in the 5-year period following this procedure. Based on the results of this study, the cluster HJ technique may be a useful surgical method enabling the secure reconstruction of severely damaged hilar bile ducts.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Myeong-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Sung-Goo
authors.initials: SG
authors.lastname: Lee
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Kwon
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001649:Bile Duct Diseases / Q000209:etiology / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D018285:Klatskin Tumor / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011171:Portoenterostomy, Hepatic / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents