ABSTRACT
Background & Aim: Roux-en-Y hepaticojejunostomy (RYHJ) is the most common treatment done for benign biliary strictures and as a part of for post CDC excision biliary drainage. In the long term follow up, RYHJ stenosis is a dreaded complication, both for the patients and the attending surgeon, in view of the complexity and difficulty in its management. This is traditionally managedby a combination of medical, radiological and open surgical techniques. There are only a few reports describing the management of strictured biliary anastomosis by a laparoscopic technique. The aim of the present study is to describe our experience of laparoscopic re- establishment of biliary continuity(Re-do hepatico-jejunostomy) Methods: Retrospective analysis of prospectively collected data of RYHJ stenosis post benign biliary stricture (BBS) repair and choledochal cyst (CDC) excision, treated by laparoscopic re-do RYHJ, between January 2018 to December 2018 in the department of GI Surgery, GB Pant Institute & Maulana Azad Medical College. Results: 6 patients underwent laparoscopic Re-do RYHJ during the study period. 4 patients developed RYHJ stenosis post open BBS repair and 2 after open CDC excision. The presenting complaints was repeated episodes of fever with jaundice, refractory to medical management. Three patients also had hepatolithiasis.
ABSTRACT
El tratamiento de la estenosis biliar benigna (EBB) constituye unreto médico, más del 70% de los casos son resueltos endoscópica-mente, reservando los más complejos para el abordaje quirúrgico,con una tasa éxito que ronda del 92 % al 60%. Una técnica qui-rúrgica impecable junto a factores favorables del paciente es la prin-cipal garantía de éxito. Objetivo: Mantener un adecuado flujo biliar es uno de los factoresprincipales para evitar inflamación y éstasis biliar, por lo que hemosemprendido el siguiente protocolo de estudio con terapia adyuvantecon ácido ursodesoxicólico posterior a la reconstrucción biliar.Métodos: Ensayo clínico prospectivo no aleatorizado, donde seincluyen pacientes con estenosis biliar benigna desde agosto 2012hasta agosto 2014.Resultados:Se han incluido 13 pacientes con preponderancia delsexo femenino con un 77 %, las estenosis tipo Bismuth 1 y 2 ocu-paron un 23 %, mientras que para Bismuth 4 y 5 un 15,38 % res-pectivamente, las EBB producto en anastomosis biliodigestiva ocu-rrió en un 23 %. El seguimiento promedio fue de 13,3 meses.Posterior al tratamiento, sólo 1 paciente experimentó colangitis enausencia de estenosis. Hasta la fecha de seguimiento ninguno hapresentado re-estenosis.Conclusión: Una técnica quirúrgica impecable junto al tratamientoadyuvante con ácido ursodesoxicólico pareciera ofrecer buenosresultados a fin de evitar la re-estenosis y la colangitis, por lo que suaplicación debe ser estudiada por periodos de tiempo prolongados(AU)
The benign biliary stenosis is a medical challenge; more than 70%of them are resulted endoscopically, leaving the most difficult casesfor surgical treatment, which can reach a success between 92% and60%. Meticulous surgical techniques with better patient prognosticfactors are guarantee of success. Objective:The adequate biliary flow is related with less inflationand less biliary stasis, that's why we decide to use ursodesoxicolicacid as an adjuvant treatment after biliary reconstruction surgery.Methods: Non randomized clinical trial, including patients betweenAugust 2012 to August 2014 with benign biliary stenosis.Results:Were included 13 patients, most of them women 77%.Type 1 and 2 Bismuth 23%, Bismuth 4 -5 15,38 % respectively, and23 % for stenosis of the biliodigestive anastomosis. The medianfollow up was 13,3 months. After surgical reconstruction there wereonly 1 patient who revealed cholangitis, and no restenosis in thefollow up period. Conclusion:A meticulous surgical technique and adjuvant treat-ment with ursobilanic acid seem to show good results avoiding re-stenosis and cholangitis, prolong study period is required(AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Ursodeoxycholic Acid , Bile Ducts , Constriction, Pathologic , Endoscopy , General Surgery , Wounds and Injuries , Cholangitis , CholestasisABSTRACT
Situs inversus, a left-to-right transposition of the normally asymmetrical organs of the body, is a rare anomaly that occurs in 1:5,000-1:10,000 adults. In the total form, the thoracic organs, as well as the abdominal organs, are completely reversed in a "mirror image" of their normal arrangement. Herein, we present a case of an adenocarcinoma of the proximal bile duct in a 68-year-old man with total situs inversus. Without any technical problems, he successfully underwent a bile-duct resection and bilioenteric anastomosis. He did well postoperatively, and after one course of chemotherapy, was discharged on postoperative day 12. A review of the international literature on this subject is presented.