Application of hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in the treatment of high level bile duct injuries / 中华肝胆外科杂志

ABSTRACT

Objective@#To study hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in treatment of high level bile duct injuries (BDI).@*Methods@#From January 2000 to January 2018, eleven patients with high level BDI caused by laparoscopic cholecystectomy (LC) were treated in Mianyang Central Hospital with hemihepatectomy combined with a circular-stretching suturing technique in the bile duct anastomosis. The hilar confluence was involved in all these patients. A total of six patients had combined right hepatic artery injury with 1 having associated right portal vein injury. A total of five patients had developed right liver atrophy. The median time interval from LC to hepatectomy was 17.0(2.0~61.0) months. The number of previously attempted biliary repairs was 1~4 times (median 2 times). The bile duct anastomosis was performed by the circular-stretching suturing technique.@*Results@#There was no perioperative death. One patient underwent left hemihepatectomy and 10 patients right hemihepatectomy. Roux-en-Y hepaticojejunostomy was carried out in 9 patients, and bile duct end-to-end anastomosis in 2 patients. The operation time was (245.9±87.4) min, intraoperative blood loss (655.7±413.6) ml, and the median postoperative hospital stay 12.0(7.0~29.0) days. Five patients developed complications. The median follow-up was 47.0(15.0~89.0) months. One patient developed anastomotic stenosis and 1 patient had cholangitis. The remaining 9 patients were well.@*Conclusion@#After adequate preoperative preparation, patients who were treated with hemihepatectomy combined with the circular-stretching suturing technique for bile duct anastomosis to treat high level BDI achieved good results.