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Portoenterostomy as a Salvage Procedure for Major Biliary Complications Following Hepaticojejunostomy

Lookup NU author(s): John Hammond

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Abstract

© 2017, The Society for Surgery of the Alimentary Tract.Major biliary complications that require surgical intervention after hepaticojejunostomy are rare and technically challenging. While the hepaticojejunostomy can be refashioned in most patients requiring surgical reexploration after anastomotic dehiscence, a selected few may require a portoenterostomy, which involves anastomosis of the jejunum to a decapsulated area of the liver to establish a conduit from the intrahepatic bile ducts to the intestine. Herein, we describe the technique where a portoenterostomy has been used to restore bilioenteric continuity in three patients where reconstruction with a hepaticojejunostomy was not feasible. All patients survived the procedure and two needed percutaneous transhepatic biliary dilatation after 5 years and 6 months, respectively. One patient died of unrelated causes 12 years after the initial procedure and the other two are alive with normal bilirubin and intrahepatic ducts at 14 and 4 years. In rare cases where hepaticojejunostomy is not feasible due to small, friable or inflamed hepatic ducts, portoenterostomy with transanastomotic stenting provides an effective way of saving life and restoring bilioenteric continuity. Although this is not a procedure to be recommended without due consideration of other options, we have shown it can be life-saving and provide good long-term results in combination with postoperative radiological intervention, when necessary.

Publication metadata

Author(s): Sharma A, Hammond JS, Psaltis E, Dunn WK, Lobo DN

Publication type: Article

Publication status: Published

Journal: Journal of Gastrointestinal Surgery

Year: 2017

Volume: 21

Issue: 6

Pages: 1086-1092

Print publication date: 01/06/2017

Online publication date: 08/02/2017

Acceptance date: 17/01/2017

ISSN (print): 1091-255X

ISSN (electronic): 1873-4626

Publisher: Springer New York LLC

URL: https://doi.org/10.1007/s11605-017-3372-7

DOI: 10.1007/s11605-017-3372-7

PubMed id: 28181137

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