Percutaneous Cholangioscopic Bilioenterostomy for Unreconstructed Segmental Bile Duct after Hepatobiliary Resection for Hilar Cholangiocarcinoma

During a major hepatectomy, inadvertent ligation of the major segmental bile-duct branch of the liver remnant is a serious complication. We experienced this serious complication of inadvertent ligation of the bile-duct branch, which should be anastomosed to the jejunal loop, during a left hepatic trisegmentectomy with total caudate lobectomy for a hilar cholangiocarcinoma. A percutaneous transhepatic bilioenteric connection was then created, modifying an endoscopic ureteroneocystostomy technique, between the ligated segmental bile duct and the jejunal loop. In this procedure, we used two cholangioscopes; one was introduced through the percutaneous transhepatic drainage route, the other was introduced through an enterostomy which was made during the surgery for postoperative enteral feeding; we also used a transjugular intrahepatic portosystemic shunt (TIPS) kit under fluoroscopic guidance. We present here our technique of percutaneous transhepatic bilioenterostomy.

References

• 1 Soulez G, Gagner M, Thérase E, et al. Malignant biliary obstruction: preliminary results of palliative treatment with hepaticogastrostomy under fluoroscopic, endoscopic, and laparoscopic guidance.  Radiology. 1994;  1992 241-246
• 2 Soulez G, Thérase E, Oliva V L, et al. Left hepaticogastrostomy for biliary obstruction: long-term results.  Radiology. 1997;  204 780-786
• 3 Suzuki H, Iyomasa S, Nimura Y, Yoshida S. Internal biliary drainage, unlike external drainage, does not suppress the regeneration of cholestatic rat liver after partial hepatectomy.  Hepatology. 1994;  20 1318-1322
• 4 Strup S E, Bagley D H. Endoscopic ureteroneocystostomy for complete obstruction at the ureterovesical junction.  J Urol. 1996;  156 360-362
• 5 Lammer J, Hausegger K, Flückiger F, et al. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents.  Radiology. 1996;  201 167-172
• 6 David P HP, Groen A K, Rauws E AJ, et al. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction.  Lancet. 1992;  2 1488-1492
• 7 Culp W C, McCowen T C, Lieberman R P, et al. Biliary stricture in liver transplant recipients: treatment with metal stents.  Radiology. 1996;  199 339-346
• 8 Takada T, Hanyu F, Kobayashi S, Uchida Y. Percutaneous transhepatic cholangial drainage: direct approach under fluoroscopic control.  J Surg Oncol. 1976;  8 83-97
• 9 Nimura Y, Kamija J, Kondo S, et al. Technique of inserting multiple biliary drains and management.  Hepatogastroenterology. 1995;  42 323-331