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. Objectives: 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. Materials and Methods: In this case series, we prospectively collected data of ۲۲ patients, who underwent first time biliary reconstruction through Roux-en-y hepaticojejunostomy followed by hepatic duct stenting using a trans-jejunal bifurcated ۶F 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 ۲۲ patients including four males (۱۸.۱%) and ۱۸ females (۸۱.۸%) were evaluated. The mean age was ۴۲.۷۱ (range: ۲۳ - ۷۴) years. Twelve patients had undergone open cholecystectomy (۵۴.۵%) and the rest had a history of laparoscopic cholecystectomy. The mean interval between the primary operation and reconstruction was ۹۲.۷۱ days. The mean follow-up period after biliary reconstruction was ۴۲.۳۳ (range: ۱ - ۹۶) 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.

Keywords:

biliary tract , Reconstruction , Treatment outcome , bile duct , Iatrogenic