Mechanical hepaticojejunostomy: can we use a circular stapler as a viable and safe alternative? -a retrospective study of a single center.

BACKGROUND: Since the first years of the 1980s, some authors described the use of mechanical stapler for the creation of anastomosis in biliary surgery. However, the use of these devices has not spread during the following decades, and nowadays most centers usually craft hand-sewn anastomosis. METHODS: We retrospectively collected data from medical records, surgical registries and computerized databases about the use of mechanical circular staplers for the creation of hepaticojejunostomy at our institution. RESULTS: From 2012 to 2020, 11 stapled hepaticojejunostomy for both neoplastic and non-neoplastic diseases were performed at our institution. The mean age of the patient was 74, with a sex distribution of 5 men and 6 women. The mean preoperative common bile duct diameter was 19 mm. Preoperative blood samples showed mean total bilirubin of 6.95 mg/dL. No intraoperative complications were reported. Two patients (18%) had minor postoperative complications (1 wound dehiscence and 1 episode of melena that required blood transfusions), while no major complications occurred. No patients developed biliary fistula or anastomotic dehiscence. No one dies within 30 days from surgery. The mean postoperative length of stay was 13 days. CONCLUSIONS: According to our limited experience, stapled hepaticojejunostomy seems to be a safe and effective technique in selected patients.

Comparative assessment of bile duct decompression methods in patients with obstructive jaundice of non-tumor genesis.

OBJECTIVE: Introduction: Obstructive jaundice is one of the most common diseases of the digestive system observed in 10-15% of the world's population. The question of making a choice among methods of bile duct decompression is still under discussion, since both single-stage and two-stage methods of biliary decompression lead to progression of hepatic insufficiency after restoration of bile passage. The aim: To determine a tempo of biliary decompression after external and internal drainage of bile ducts, endoscopic transpapillary interventions in patients with obstructive jaundice of non-tumor genesis. PATIENTS AND METHODS: Materials and methods: We analyzed the outcomes of surgical treatment of 180 patients with obstructive jaundice of the non-tumor genesis. The patients were divided into three groups: group I (n = 86), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 46), where the external drainage of bile ducts was conducted. The average age was 62 ± 6.0 years. The average duration of obstructive jaundice was 20 ± 3.7 days. RESULTS: Results: The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphatase on Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier. CONCLUSION: Conclusions: No significant disturbances of the functional state of the liver after endoscopic transpapillary interventions were observed. Formation of areflux biliodigestive anastomoses was accompanied by a moderate rate of biliary duct decompression. The external drainage of biliary ducts was characterized by a rapid rate of biliary decompression, leading to a post-compression syndrome.

La hepaticoyeyunostomía en el tratamiento de las afecciones hepatobiliopancreáticas / Hepaticojejunostomy in the treatment of affections

Introducción: el tratamiento de las afecciones del sistema hepatobiliopancreático dista mucho de ser el óptimo a pesar de los avances conseguidos con la incorporación de nuevos procedimientos diagnósticos y terapéuticos; sin embargo, las derivaciones bilioentéricas son consideradas una alternativa valiosa en el tratamiento. Objetivo: caracterizar el tratamiento de las afecciones del sistema hepatobiliopancreático con el uso de la hepaticoyeyunostomía, en el servicio de cirugía general del hospital Dr. Salvador Allende, desde enero de 2000 hasta diciembre de 2013. Métodos: estudio de corte transversal, retrospectivo-prospectivo y descriptivo. La muestra estuvo constituida por 77 pacientes. Resultados: las enfermedades del sistema hepatobiliopancreático malignas representaron el principal diagnóstico entre nuestros pacientes, con 31 por ciento de complicaciones posoperatoria y cuatro (5,19 por ciento) muertes asociadas al proceder. Conclusiones: la hepaticoyeyunostomía es una opción terapéutica segura en aquellos pacientes con enfermedad hepatobiliopancreática cuando no exista la adecuada factibilidad de métodos endoscópicos derivativos, ante el fallo de estos o el fracaso de la descompresión percutánea(AU)

Introduction: the treatment of disorders of the hepatobiliopancreatic system is far from being despite the progress made with the incorporation of new diagnostic and therapeutic procedures; however, biliary-enteric by-passes are considered a valuable alternative in the treatment. Objective: to characterize the treatment of hepatobiliopancreatic system affections using hepaticojejunostomy, in the Department of General Surgery Dr. of Salvador Allende Hospital, from January 2000 to December 2013. Methods: a cross-sectional, retrospective-prospective and descriptive study was carried out. The sample consisted of 77 patients. Results: the malignant disease of the hepatobiliopancreatic system were the main diagnosis among our patients, with 31 percent of postoperative complications and four (5.19 percent) deaths associated with the procedure. Conclusions: hepaticojejunostomy is a safe therapeutic option for patients with hepatobiliopancreatic disease, when there is no adequate feasibility of endoscopic derivative methods, in face of the failure of these or that of percutaneous decompression(AU)

La hepaticoyeyunostomÍa en el tratamiento de las afecciones hepatobiliopancreáticas / Hepaticojejunostomy in the treatment of affections

Introducción: el tratamiento de las afecciones del sistema hepatobiliopancreático dista mucho de ser el óptimo a pesar de los avances conseguidos con la incorporación de nuevos procedimientos diagnósticos y terapéuticos; sin embargo, las derivaciones bilioentéricas son consideradas una alternativa valiosa en el tratamiento. Objetivo: caracterizar el tratamiento de las afecciones del sistema hepatobiliopancreático con el uso de la hepaticoyeyunostomía, en el servicio de cirugía general del hospital "Dr. Salvador Allende", desde enero de 2000 hasta diciembre de 2013. Métodos: estudio de corte transversal, retrospectivo-prospectivo y descriptivo. La muestra estuvo constituida por 77 pacientes.Resultados: las enfermedades del sistema hepatobiliopancreático malignas representaron el principal diagnóstico entre nuestros pacientes, con 31 por ciento de complicaciones posoperatoria y cuatro (5,19 por ciento) muertes asociadas al proceder. Conclusiones: la hepaticoyeyunostomía es una opción terapéutica segura en aquellos pacientes con enfermedad hepatobiliopancreática cuando no exista la adecuada factibilidad de métodos endoscópicos derivativos, ante el fallo de estos o el fracaso de la descompresión percutánea(AU)

Introduction: the treatment of disorders of the hepatobiliopancreatic system is far from being despite the progress made with the incorporation of new diagnostic and therapeutic procedures; however, biliary-enteric by-passes are considered a valuable alternative in the treatment. Objective: to characterize the treatment of hepatobiliopancreatic system affections using hepaticojejunostomy, in the Department of General Surgery Dr. of Salvador Allende Hospital, from January 2000 to December 2013. Methods: a cross-sectional, retrospective-prospective and descriptive study was carried out. The sample consisted of 77 patients. Results: the malignant disease of the hepatobiliopancreatic system were the main diagnosis among our patients, with 31 percent of postoperative complications and four (5.19 percent) deaths associated with the procedure. Conclusions: hepaticojejunostomy is a safe therapeutic option for patients with hepatobiliopancreatic disease, when there is no adequate feasibility of endoscopic derivative methods, in face of the failure of these or that of percutaneous decompression(AU)

Cholangitis in the postoperative course after biliodigestive anastomosis.

BACKGROUND: Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course. METHODS: Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis. RESULTS: Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (p < 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (p = 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (n = 12, p = 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively. CONCLUSION: The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.

No infectious hepatic complications following radioembolization with 90Y microspheres in patients with biliodigestive anastomosis.

AIM: To retrospectively evaluate infectious hepatic complications of transarterial radioembolization (RE) of the liver in patients with pre-existing biliodigestive anastomosis. PATIENTS AND METHODS: Patients who underwent RE were retrospectively analyzed. All patients had at least a contrast-enhanced magnetic resonance imaging or contrast-enhanced triple-phase computed tomographic scan before and 6-8 weeks after RE. RESULTS: Overall, 143 patients (67 women, 76 men; median age = 65 ± 11.2 years) were analyzed. Nine patients had a biliodigestive anastomosis. The complications were as follows: one case of cholecystitis, three of gastroduodenal ulcer with one ulcer perforation, and six of radioembolization-induced liver disease. There were no infectious complications. There were no major or minor complications in the group with previous biliodigestive anastomosis. CONCLUSION: Pre-existing bilioenteric anastomoses are not a negative predictive factor for the development of infectious hepatic complications after RE. RE with (90)Y microspheres can be safely performed following careful patient selection.