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Techniques of biliary reconstruction following bile duct resection (with video)

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Title: Techniques of biliary reconstruction following bile duct resection (with video)
Authors: Hirano, Satoshi Browse this author →KAKEN DB
Tanaka, Eiichi Browse this author →KAKEN DB
Tsuchikawa, Takahiro Browse this author
Matsumoto, Joe Browse this author
Shichinohe, Toshiaki Browse this author →KAKEN DB
Kato, Kentaro Browse this author →KAKEN DB
Keywords: Biliary reconstruction
Bilioenteric anastomosis
Hepatobiliary resection
Issue Date: May-2012
Publisher: Springer Japan
Journal Title: Journal of Hepato-Biliary-Pancreatic Sciences
Volume: 19
Issue: 3
Start Page: 203
End Page: 209
Publisher DOI: 10.1007/s00534-011-0475-5
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.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 平野 聡

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