Temporary Trans-jejunal Hepatic Duct Stenting in Roux-en-y Hepaticojejunostomy for Reconstruction of Iatrogenic Bile Duct Injuries.
BACKGROUND
Bile Duct Injuries (BDI) during cholecystectomy are now being recognized as major health problems.


OBJECTIVE
Herein, we present our experience with handling major BDIs and report long-term outcome of hepaticojejunostomies followed by trans-jejunal hepatic duct stenting performed to reconstruct extra-hepatic biliary tracts.


METHODS
In this case series, we prospectively collected data of 22 patients, who underwent first time biliary reconstruction through Roux-en-y hepaticojejunostomy followed by hepatic duct stenting using a trans-jejunal bifurcated 6F tube drain. The long-term outcome was assessed and defined as excellent (asymptomatic, normal liver enzymes and bilirubin levels), good (asymptomatic, mild abnormality in liver enzyme and bilirubin levels), poor (symptomatic, abnormal liver enzymes and bilirubin level) and failure (requiring reoperation).


RESULTS
A total of 22 patients including four males (18.1%) and 18 females (81.8%) were evaluated. The mean age was 42.71 (range: 23 - 74) years. Twelve patients had undergone open cholecystectomy (54.5%) and the rest had a history of laparoscopic cholecystectomy. The mean interval between the primary operation and reconstruction was 92.71 days. The mean follow-up period after biliary reconstruction was 42.33 (range: 1 - 96) months. No instance of anastomotic leakage or stenosis, biliary sepsis, thromboembolic event, or respiratory infection was noted in the long-term follow-up. The outcome was excellent in all patients. No case with poor or failure of result was noticed.


CONCLUSIONS
Although a devastating complication iatrogenic major bile duct injuries can be corrected surgically with a high rate of success. Temporary trans-jejunal stenting of the hepatic ducts can help in maintaining the integrity of anastomosis without stenosis or biliary sepsis.
Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran.
Mohammad
M
Sadegh Fazeli
Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran.
Ali Reza
AR
Kazemeini
Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran.
Ali
A
Jafarian
Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran.
Mohammad
M
Bashashati
Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran.
Mohammad Reza
MR
Keramati
Biliary Tract; Iatrogenic; Reconstruction; Treatment Outcome, Bile Duct