RSS-Feed abonnieren
DOI: 10.1055/s-0042-1757343
Stepwise Percutaneous Approach to Treat Severe Benign Hepaticojejunostomy Stenosis
![](https://www.thieme-connect.de/media/sir/202204/lookinside/thumbnails/10-1055-s-0042-1757343_001400-1.jpg)
Hepaticojejunostomy surgery was first introduced in 1949.[1] It is often performed to relieve an extrahepatic biliary obstruction or to restore biliary-enteric continuity as part of operations such as total pancreatectomy, Whipple's procedure, and liver transplantation.[1] [2] Hepaticojejunostomy anastomotic stenosis is one of the main complications that can result in reduced survival and quality of life.[3] The incidence of hepaticojejunostomy stenosis ranges from 9 to 15% in nontransplant settings, and up to 30% in liver transplant recipients.[4] [5] Biliary-enteric anastomotic stenosis is a late complication and is usually diagnosed 12 to 18 months after the surgery.[6] [7] In recent decades, acute postsurgical complications and mortality rates have declined, and the survival rates have increased; therefore, more cases present with late hepaticojejunostomy stenosis.[8] [9]
Severe hepaticojejunostomy stenosis is more often reported after Roux-en-Y and choledochojejunostomy than duct-to-duct anastomosis.[10] Strictures that present in the early postoperative period mostly result from technical factors including small duct size, inappropriate suture material, excess tension at the anastomotic site, infection, and excessive cautery use.[11] Late biliary stenoses are often caused by vascular insufficiency, poor healing, and fibrosis.[12] These complications are associated with additional interventions, repeat hospitalizations, and an overall decline in the quality of life.[5] Surgical revision can be exceedingly difficult, technically challenging, and is associated with increased morbidity and mortality.[2] The treatment options have gradually shifted from surgical revision to primarily minimally invasive management.[13]
Intraluminal endoscopy is considered the first step to treating postsurgical hepaticojejunostomy strictures, though, in some instances, the anastomosis may not be amenable to endoscopic access. In such cases with failed endoscopy, percutaneous treatments including percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD), balloon dilatation, and stent placement can help restore patency for the majority of cases.[8] [14] More recently, the introduction of percutaneous cholangioscope-assisted procedures has widened the range of procedures offered by interventional radiology to patients with failed conventional percutaneous approaches.[15] [16] [17]
Financial Disclosures
None declared.
Publikationsverlauf
Artikel online veröffentlicht:
17. November 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Sanders RL. Hemihepatectomy with hepaticojejunostomy for irreparable defects of the bile ducts. Arch Surg 1949; 58 (06) 752-761
- 2 Moris D, Papalampros A, Vailas M, Petrou A, Kontos M, Felekouras E. The hepaticojejunostomy technique with intra-anastomotic stent in biliary diseases and its evolution throughout the years: a technical analysis. Gastroenterol Res Pract 2016; 2016: 3692096
- 3 Zafar SN, Khan MR, Raza R. et al. Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis. BMC Surg 2011; 11: 19
- 4 Chok KS, Lo CM. Prevention and management of biliary anastomotic stricture in right-lobe living-donor liver transplantation. J Gastroenterol Hepatol 2014; 29 (10) 1756-1763
- 5 Dimou FM, Adhikari D, Mehta HB, Olino K, Riall TS, Brown KM. Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery 2016; 160 (03) 691-698
- 6 Kadaba RS, Bowers KA, Khorsandi S. et al. Complications of biliary-enteric anastomoses. Ann R Coll Surg Engl 2017; 99 (03) 210-215
- 7 Zhu JQ, Li XL, Kou JT. et al. Bilioenteric anastomotic stricture in patients with benign and malignant tumors: prevalence, risk factors and treatment. Hepatobiliary Pancreat Dis Int 2017; 16 (04) 412-417
- 8 House MG, Cameron JL, Schulick RD. et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243 (05) 571-576 , discussion 576–578
- 9 Mizukawa S, Tsutsumi K, Kato H. et al. Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple's procedure: a retrospective study. BMC Gastroenterol 2018; 18 (01) 14
- 10 Williams ED, Draganov PV. Endoscopic management of biliary strictures after liver transplantation. World J Gastroenterol 2009; 15 (30) 3725-3733
- 11 Koneru B, Sterling MJ, Bahramipour PF. Bile duct strictures after liver transplantation: a changing landscape of the Achilles' heel. Liver Transpl 2006; 12 (05) 702-704
- 12 Verdonk RC, Buis CI, Porte RJ. et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl 2006; 12 (05) 726-735
- 13 Millis JM, Tompkins RK, Zinner MJ, Longmire Jr WP, Roslyn JJ. Management of bile duct strictures. An evolving strategy. Arch Surg 1992; 127 (09) 1077-1082 , discussion 1082–1084
- 14 Bonnel DH, Fingerhut AL. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg 2012; 203 (06) 675-683
- 15 Kord A, Makramalla A, Zhang L, Sriwastwa A, Chadalavada S. Percutaneous cholangioscope-assisted laser incision of severe benign hepaticojejunostomy stenoses. J Vasc Interv Radiol 2022; 33 (08) 1001-1004
- 16 Martins FP, Ferrari AP. Cholangioscopy-assisted guidewire placement in post-liver transplant anastomotic biliary stricture: efficient and potentially also cost-effective. Endoscopy 2017; 49 (11) E283-E284
- 17 Woo YS, Lee JK, Noh DH, Park JK, Lee KH, Lee KT. SpyGlass cholangioscopy-assisted guidewire placement for post-LDLT biliary strictures: a case series. Surg Endosc 2016; 30 (09) 3897-3903
- 18 Krokidis M, Orgera G, Rossi M, Matteoli M, Hatzidakis A. Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review. Insights Imaging 2013; 4 (01) 77-84
- 19 Choi SH, Han JK, Lee JM. et al. Differentiating malignant from benign common bile duct stricture with multiphasic helical CT. Radiology 2005; 236 (01) 178-183
- 20 Singh A, Gelrud A, Agarwal B. Biliary strictures: diagnostic considerations and approach. Gastroenterol Rep (Oxf) 2015; 3 (01) 22-31
- 21 Kapoor BS, Esparaz A, Levitin A, McLennan G, Moon E, Sands M. Nonvascular and portal vein applications of cone-beam computed tomography: current status. Tech Vasc Interv Radiol 2013; 16 (03) 150-160
- 22 Kapoor BS, Mauri G, Lorenz JM. Management of biliary strictures: state-of-the-art review. Radiology 2018; 289 (03) 590-603
- 23 Chahal P, Baron TH, Topazian MD, Petersen BT, Levy MJ, Gostout CJ. Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy 2006; 38 (12) 1241-1245
- 24 Riaz A, Salem R. Future directions of percutaneous biliary interventions. Semin Intervent Radiol 2021; 38 (03) 373-376
- 25 Kord A, Patel M, Bui JT. Totally percutaneous rendezvous technique for the treatment of complete biliary obstruction after liver transplant. Radiol Case Rep 2022; 17 (04) 1284-1287
- 26 Song G, Zhao HQ, Liu Q, Fan Z. A review on biodegradable biliary stents: materials and future trends. Bioact Mater 2022; 17: 488-495
- 27 De Gregorio MA, Criado E, Guirola JA. et al; Spanish Group BiELLA (SERVEI). Absorbable stents for treatment of benign biliary strictures: long-term follow-up in the prospective Spanish registry. Eur Radiol 2020; 30 (08) 4486-4495
- 28 Siiki A, Jesenofsky R, Löhr M. et al. Biodegradable biliary stents have a different effect than covered metal stents on the expression of proteins associated with tissue healing in benign biliary strictures. Scand J Gastroenterol 2016; 51 (07) 880-885
- 29 Ndzengue A, Hammoudeh F, Brutus P. et al. An obscure case of hepatic subcapsular hematoma. Case Rep Gastroenterol 2011; 5 (01) 223-226
- 30 Otto W, Sierdziński J, Smaga J, Dudek K, Zieniewicz K. Long-term effects and quality of life following definitive bile duct reconstruction. Medicine (Baltimore) 2018; 97 (41) e12684