Cluster hepaticojejunostomy with radial spreading anchoring traction technique for secure reconstruction of widely opened hilar bile ducts.
10.14701/kjhbps.2016.20.2.66
- Author:
Shin HWANG
1
;
Tae Yong HA
;
Gi Won SONG
;
Dong Hwan JUNG
Author Information
1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Cluster hepaticojejunostomy;
Perihilar cholangiocarcinoma;
Bile duct injury;
Percutaneous transhepatic biliary drainage;
Radial spreading anchoring traction
- MeSH:
Bile Ducts*;
Bile*;
Connective Tissue;
Drainage;
Hepatic Duct, Common;
Stents;
Sutures;
Traction*
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2016;20(2):66-70
- CountryRepublic of Korea
- Language:English
-
Abstract:
Secure reconstruction of multiple hepatic ducts that are severely damaged by tumor invasion or iatrogenic injury is a challenge. Failure of percutaneous or endoscopic biliary stenting requires lifelong placement of one or more percutaneous transhepatic biliary drainage (PTBD) tubes. For such difficult situations, we devised a surgical technique termed cluster hepaticojejunostomy (HJ), which can be coupled with palliative bile duct resection. The cluster HJ technique consisted of applying multiple internal biliary stents and a single wide porto-enterostomy to the surrounding connective tissues. The technique is described in detail in the present case report. Performing cluster HJ benefits from three technical tips as follows: making the multiple bile duct openings wide and parallel after sequential side-to-side unification; radially anchoring and traction of the suture materials at the anterior anastomotic suture line; and making multiple segmented continuous sutures at the posterior anastomotic suture line. Thus, cluster HJ with radial spreading anchoring traction technique is a useful surgical method for secure reconstruction of severely damaged hilar bile ducts.
