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KMID : 0870420160200020066
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2016 Volume.20 No. 2 p.66 ~ p.70
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Cluster hepaticojejunostomy with radial spreading anchoring tractiontechnique for secure reconstruction of widely opened hilar bile ducts
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Hwang Shin
Ha Tae-Yong
Song Gi-Won
Jung Dong-Hwan
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Abstract
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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.
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KEYWORD
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Cluster hepaticojejunostomy, Perihilar cholangiocarcinoma, Bile duct injury, Percutaneous transhepatic biliary drainage, Radial spreading anchoring traction
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