"Sideways": Results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy

Emily R. Winslow, Elizabeth Fialkowski, David C. Linehan, William G. Hawkins, Daniel D. Picus, Steven M. Strasberg

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)426-434
Number of pages9
JournalAnnals of Surgery
Volume249
Issue number3
DOIs
StatePublished - Mar 2009
Externally publishedYes

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Jejunostomy
Wounds and Injuries
Cholecystectomy
Pathologic Constriction
Reoperation
Common Hepatic Duct
Bile Ducts
Dissection
Dilatation

ASJC Scopus subject areas

  • Surgery

Cite this

"Sideways" : Results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. / Winslow, Emily R.; Fialkowski, Elizabeth; Linehan, David C.; Hawkins, William G.; Picus, Daniel D.; Strasberg, Steven M.

In: Annals of Surgery, Vol. 249, No. 3, 03.2009, p. 426-434.

Research output: Contribution to journalArticle

Winslow, Emily R. ; Fialkowski, Elizabeth ; Linehan, David C. ; Hawkins, William G. ; Picus, Daniel D. ; Strasberg, Steven M. / "Sideways" : Results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. In: Annals of Surgery. 2009 ; Vol. 249, No. 3. pp. 426-434.
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abstract = "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.",
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AB - 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.

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