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>Journals >Cirujano General >Year 2010, Issue 3


Mercado MÁ, Arriola JC, Domínguez I, Olaíz AE, Urencio M, Ramírez VF, Aramburo R
Iatrogenic injury of the bile duct with lost of confluence: surgical options
Cir Gen 2010; 32 (3)

Language: Español
References: 23
Page: 160-166
PDF: 4. Kb.


Full text




ABSTRACT

Objective: To describe the experience in repairing iatrogenic injuries to the bile duct with loss of confluence at a national reference center in Mexico.
Setting: Third level health care center, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City.
Design: Retrospective, transversal, descriptive study.
Statistical analysis: Percentages as summary measures for qualitative variables.
Patients and methods: The study comprised 43 cases with loss of confluence, in an 18-year period. Group I (GI), neoconfluence plus Roux en Y hepatojejuno- anastomosis; Group II (GII), Roux en Y portoenterostomy; Group III (GIII), double anastomosis; Group IV (GIV), major hepatectomy and hepatojejuno-anastomosis. We reviewed the clinical files of these patients, recording general information, including type of surgery and postoperative results.
Results: GI: 20 cases. One presented stenosis of the anastomosis (5%), one case of repeated cholangitis, and the other required re-intervention (5%). GII: 15 cases, three (20%) coursed with cholangitis, and three (20%) required re-operation. GIII: six cases, three with cholangitis (50%). Three had to be re-operated (two with right hepatectomy, one hepatic transplant). GIV; two cases, none required re-operation.
Conclusion: Bile duct injuries with loss of confluence represent a complex scenario. Several options have to be considered in their repair (neoconfluence, double anastomosis, hepatectomy or portoenterostomy), which have to be selected and performed after a careful analysis based on the characteristics of each patient. Construction of a neoconfluence should always be attempted whenever possible.


Key words: Bile duct injury, neoconfluence, hepatojejunostomy, hepatectomy, portoenterostomy.


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