1.Post-cholecystectomy total bile duct strictures:Cases for magnetic compression anastomosis
Freddy Pereira GRATEROL ; Francisco Salazar MARCANO ; Yajaira Venales BARRIOS ; Yeisson RIVERO-MORENO ; Dong Ki LEE
Annals of Hepato-Biliary-Pancreatic Surgery 2025;29(2):199-204
Bile duct injuries are a serious issue, and their surgical treatment carries the risk of morbidity and mortality. In selected cases, non-surgical treatments are possible, even for total strictures. We outline the technique and results of using magnetic compression anastomosis (MCA) to treat post-cholecystectomy bile duct stricture (PCBDS), in two female patients. Initially, a bilio-cutaneous tract was established via external biliary drainage, followed by the positioning of both endoscopic and percutaneous biliary magnets. After their approximation and subsequent removal, a fully covered self-expandable metal stent (FCSEMS) was deployed across the stricture.The magnet coupling was successfully achieved within the first two weeks of placement. The FCSEMS was maintained for durations of 12 and 16 months. Follow-up durations were 28 and 15 months post-FCSEMS removal. Both patients remain asymptomatic, with normal laboratory and imaging studies, and no adverse events were reported. MCA proves to be a safe and effective method for treating selected cases of total PCBDS. However, further studies and long-term follow-up are required to fully assess the efficacy of this technique.
2.Post-cholecystectomy total bile duct strictures:Cases for magnetic compression anastomosis
Freddy Pereira GRATEROL ; Francisco Salazar MARCANO ; Yajaira Venales BARRIOS ; Yeisson RIVERO-MORENO ; Dong Ki LEE
Annals of Hepato-Biliary-Pancreatic Surgery 2025;29(2):199-204
Bile duct injuries are a serious issue, and their surgical treatment carries the risk of morbidity and mortality. In selected cases, non-surgical treatments are possible, even for total strictures. We outline the technique and results of using magnetic compression anastomosis (MCA) to treat post-cholecystectomy bile duct stricture (PCBDS), in two female patients. Initially, a bilio-cutaneous tract was established via external biliary drainage, followed by the positioning of both endoscopic and percutaneous biliary magnets. After their approximation and subsequent removal, a fully covered self-expandable metal stent (FCSEMS) was deployed across the stricture.The magnet coupling was successfully achieved within the first two weeks of placement. The FCSEMS was maintained for durations of 12 and 16 months. Follow-up durations were 28 and 15 months post-FCSEMS removal. Both patients remain asymptomatic, with normal laboratory and imaging studies, and no adverse events were reported. MCA proves to be a safe and effective method for treating selected cases of total PCBDS. However, further studies and long-term follow-up are required to fully assess the efficacy of this technique.
3.Post-cholecystectomy total bile duct strictures:Cases for magnetic compression anastomosis
Freddy Pereira GRATEROL ; Francisco Salazar MARCANO ; Yajaira Venales BARRIOS ; Yeisson RIVERO-MORENO ; Dong Ki LEE
Annals of Hepato-Biliary-Pancreatic Surgery 2025;29(2):199-204
Bile duct injuries are a serious issue, and their surgical treatment carries the risk of morbidity and mortality. In selected cases, non-surgical treatments are possible, even for total strictures. We outline the technique and results of using magnetic compression anastomosis (MCA) to treat post-cholecystectomy bile duct stricture (PCBDS), in two female patients. Initially, a bilio-cutaneous tract was established via external biliary drainage, followed by the positioning of both endoscopic and percutaneous biliary magnets. After their approximation and subsequent removal, a fully covered self-expandable metal stent (FCSEMS) was deployed across the stricture.The magnet coupling was successfully achieved within the first two weeks of placement. The FCSEMS was maintained for durations of 12 and 16 months. Follow-up durations were 28 and 15 months post-FCSEMS removal. Both patients remain asymptomatic, with normal laboratory and imaging studies, and no adverse events were reported. MCA proves to be a safe and effective method for treating selected cases of total PCBDS. However, further studies and long-term follow-up are required to fully assess the efficacy of this technique.
4.Komi type 2 pancreaticobiliary maljunction:Minimal access surgical treatment (with video)
Freddy Pereira GRATEROL ; Francisco Salazar MARCANO ; Yeisson RIVERO-MORENO ; Yajaira Venales BARRIOS
Annals of Hepato-Biliary-Pancreatic Surgery 2024;28(3):393-396
Pancreaticobiliary maljunction (PBM) is associated with the development of neoplasms of bile ducts. Cholecystectomy with diversion of the biliary-pancreatic flow is considered the treatment of choice. To describe the surgical treatment employed for a patient with Komi’s type 2 PBM and its long-term results. Laparoscopic common bile duct exploration, intraoperative cholangioscopy, and Roux-en-Y hepatico-jejunostomy were performed. Postoperative evolution was satisfactory. The patient was discharge 72 hours after the surgery. There was no associated morbidity. At 62-month follow-up, clinical examination, laboratory tests, and imaging studies confirmed an adequate patency of bilio-enteric anastomosis. The surgical approach employed was effective and safe, with satisfactory long-term results.

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