1. Treatment of late stricture of hepaticojejunal anastomosis after post-cholecystectomy bile duct injuries

Authors

  • S.I. Gadiyev Departament of II Surgical Diseases, Azerbaijan Medical University, Baku, Azerbaijan, Кафедра хирургических болезней №2, Азербайджанский медицинский университет, г. Баку, Азербайджан
  • A.A. Asadova Departament of II Surgical Diseases, Azerbaijan Medical University, Baku, Azerbaijan, Кафедра хирургических болезней №2, Азербайджанский медицинский университет, г. Баку, Азербайджан

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Abstract

Hepaticojejunostomy stricture is the disastrous complication of biliary surgery, if untreated can lead to intrahepatic stones, recurrent cholangitis, biliary cirrhosis and hepatic failure. Here, we report a case with the one-more year history of recurrent cholangitis, caused by late stricture of hepaticojejunal anastomosis after iatrogenic bile duct injury.

Case: 46-year old female patient underwent Roux-en Y hepaticojejunostomy (RYHJ) with transhepatic drain following iatrogenic bile duct injury during open cholecystectomy in rural hospital. After 11 year she represent re-stricture of hepatico-jejunal anastomosis with acute recurrent cholangitis attacks and intrahepatic lithiasis. Before admitting to our center it was tried to cross the stricture radiologically with the percutaneous transhepatic dilatation. As the multiple attempt of interventional radiology failed revision surgery required. Despite technical challenge we successfully managed the patient with the revision surgery by performing hepatic resection and creating double–barrel Roux-en Y hepaticojejunostomy with transhepatic transanastomotic stent placement.

Conclusion. Hepatico-jejunal anastomotic stricture is one of the challenging and serious complication of biliary surgery resulting multiple hospital readmissions and procedure. Recently, in many referral centers treatment of the re-strictures of hepatico-jejunal anastomosis can be achieved by nonsurgical methods such as stenting with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic balloon dilatation. In cases of failure these methods, surgical treatment is considered. Nowadays in the surgical management of bilio-enteric anastomotic strictures the trend is not to drain anymore still in a number of situations this procedure cannot be avoided. In our case, double-barell hepaticojejunostomy on a transhepatic transanastomotic drain was the best choice of treatment.

Keywords

iatrogenic biliary injuries, anastomotic strictures, recurrent cholangitis, Roux-en Y hepaticojejunostomy, double-barrel hepaticojejunostomy

References

  1. Ismael HN, Cox S, Cooper A, Narula N, TJH A. The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford). 2017; 19(4): 352–8
  2. Sampaio J.A, Kruse C.K, Passarin T.L, Waechter F.L et al. Benign biliary strictures: repair and outcome with the use of silastic transhepatic and transanastomotic stents. ABCD Arq Bras Cir Dig 2010; 23(4):259-265
  3. Asadova A.A. Modern approach to the treatment of recurrent biliary strictures after iatrogenic bile duct injuries. Azerbaijan Baku. Surgery 2019; 2: 71-74
  4. Ferreira R, Loureiro R, Nunes N, Santos AA, Maio R, Cravo M, Duarte MA. Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What’s new? World J Gastrointest Endosc 2016; 8(4): 220-231
  5. Lillemoe K.D., Melton G.B., Cameron J.L. et al., “Postoperative bile duct strictures: management and outcome in the 1990s,” Ann Surg. 2000; 232(3):430-41
  6. Benkabbou A, Castaing D, Salloum C, Adam R, Azoulay D, Vibert E. Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries. Surgery.2013; 153(1):95–102
  7. Huszar O, Kokas B, Matrai P, Hegyi P, Petervari E, Vincze A, et al. Meta-analysis of the long term success rate of different interventions in benign biliary strictures. PLoS One.2017; 12(1):e0169618
  8. Costamagna G, Boskoski I. Current treatment of benign biliary strictures. Ann Gastroenterol. 2013; 26(1):37–40
  9. Mercado MA, Franssen B, Dominguez I, Arriola-Cabrera JC, Ramirez-Del Val F, Elnecave-Olaiz A, et al. Transition from a low: to a high-volume centre for bile duct repair: changes in technique and improved outcome. HPB (Oxford) 2011; 13: 767–773
  10. Jarnagin WR, Blumgart LH. Blumgart’s surgery of the liver, biliary tract, and pancreas. 5th ed. Philadelphia: Elsevier Saunders; 2012
  11. Bockova M, Pazdirek F, Krejci T, Hoch J. How a Few Centimetres can Make all the Difference: An Unusual Treatment for Recurrent Postoperative Cholangitis in a Patient with a Biliary-Enteric Anastomosis. J Clin Case Rep 2019. 9: 1219
  12. Okabayashi T, Shima Y, Sumiyoshi T. Incidence and risk factors of cholangitis after hepaticojejunostomy. J Gastrointest Surg 2018; 22(4):676-683
  13. AbdelRafee A, El-Shobari M, Askar W, Sultan AM, El Nakeeb A: Long-term follow-up of 120 patients after hepaticojejunostomy for treatment of post-cholecystectomy bile duct injuries: a retrospective cohort study. Int J Surg 2015 18: 205–210

Published

2022-03-02

Issue

No. 1 (2022)

Section

Статьи