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Transhepatic metallic stenting for hepaticojejunostomy stricture following laparoscopic cholecystectomy biliary injury: A case of successful 20 years follow-up.

Donatelli G, Mutter D, Dhumane P, Callari C, Marescaux J - J Minim Access Surg (2012)

Bottom Line: Advances in interventional endoscopy and percutaneous techniques have made stenting a preferred treatment modality for the management of these strictures.We report successful 20 years of follow-up of a case of trans-hepatic metallic stenting (2 Gianturco(®) prostheses, 5 cm long, 2 cm in diameter) done for stenosed hepatico-jejunostomy anastomosis after laparoscopic CBD injury.Percutaneous transhepatic stenting and long-term placement of metallic stents need to be re-evaluated as a minimally invasive definitive treatment option for benign biliary strictures in patients with altered anatomy such as hepatico-jejunostomy or in whom re-operation involves high risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal and Endocrinal Surgery, IRCAD/EITS, University of Strasbourg, Strasbourg, France.

ABSTRACT
Laparoscopic cholecystectomy is still associated with a considerable rate of biliary injuries and related strictures. Advances in interventional endoscopy and percutaneous techniques have made stenting a preferred treatment modality for the management of these strictures. We report successful 20 years of follow-up of a case of trans-hepatic metallic stenting (2 Gianturco(®) prostheses, 5 cm long, 2 cm in diameter) done for stenosed hepatico-jejunostomy anastomosis after laparoscopic CBD injury. Percutaneous transhepatic stenting and long-term placement of metallic stents need to be re-evaluated as a minimally invasive definitive treatment option for benign biliary strictures in patients with altered anatomy such as hepatico-jejunostomy or in whom re-operation involves high risk.

No MeSH data available.


Related in: MedlinePlus

Percutaneous transhepatic cholangiography (dye injection in left duct) at the time of stent deployment: Two 5 cm transhepatic Gianturco® prostheses placed through the right ducts across the anastomosis. The lower prosthesis is fully open; the upper, located in normal size duct, is partially open
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Figure 1: Percutaneous transhepatic cholangiography (dye injection in left duct) at the time of stent deployment: Two 5 cm transhepatic Gianturco® prostheses placed through the right ducts across the anastomosis. The lower prosthesis is fully open; the upper, located in normal size duct, is partially open

Mentions: A 51-year-old man underwent a laparoscopic cholecystectomy for cholelithiasis 20 years ago. Post-operatively, re-exploration was done because he developed jaundice and peritonitis and complete trans-section of CBD was evident. A T-tube stented end-to-end choledochal anastomosis was performed. Jaundice regressed, but the patient remained febrile. After 12 days, bleeding was observed in the T-tube and drains with metabolic acidosis, acute renal failure and respiratory distress. After resuscitation, a surgical re-exploration demonstrated a right hepatic artery bleeding with complete dehiscence of the choledochal anastomosis. After hemostasis, the distal end of the CBD was ligated and its proximal portion was drained to the skin over the biliary stent (Cron prostheses). Ten weeks later, a Roux-en-Y hepaticojejunostomy was fashioned. The T-tube inserted at the time of operation was removed after two months. Four months later, the hepaticojejunostomy got stenosed resulting in dilatation of the intrahepatic ducts. The re-operation was considered highly challenging and a percutaneous radiological stenting was planned. Two Gianturco® prostheses, 5 cm long, 2 cm in diameter, were successfully placed using a percutaneous transhepatic route, one after the other, across the stenosis [Figure 1]. The outcome was favourable with gradual normalization of hepatic laboratory values, and normal calibre of intrahepatic ducts. Patient was successfully followed up at regular intervals with laboratory and ultrasound investigations for 5 years and showed no signs of obstructive biliopathy.


Transhepatic metallic stenting for hepaticojejunostomy stricture following laparoscopic cholecystectomy biliary injury: A case of successful 20 years follow-up.

Donatelli G, Mutter D, Dhumane P, Callari C, Marescaux J - J Minim Access Surg (2012)

Percutaneous transhepatic cholangiography (dye injection in left duct) at the time of stent deployment: Two 5 cm transhepatic Gianturco® prostheses placed through the right ducts across the anastomosis. The lower prosthesis is fully open; the upper, located in normal size duct, is partially open
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3401726&req=5

Figure 1: Percutaneous transhepatic cholangiography (dye injection in left duct) at the time of stent deployment: Two 5 cm transhepatic Gianturco® prostheses placed through the right ducts across the anastomosis. The lower prosthesis is fully open; the upper, located in normal size duct, is partially open
Mentions: A 51-year-old man underwent a laparoscopic cholecystectomy for cholelithiasis 20 years ago. Post-operatively, re-exploration was done because he developed jaundice and peritonitis and complete trans-section of CBD was evident. A T-tube stented end-to-end choledochal anastomosis was performed. Jaundice regressed, but the patient remained febrile. After 12 days, bleeding was observed in the T-tube and drains with metabolic acidosis, acute renal failure and respiratory distress. After resuscitation, a surgical re-exploration demonstrated a right hepatic artery bleeding with complete dehiscence of the choledochal anastomosis. After hemostasis, the distal end of the CBD was ligated and its proximal portion was drained to the skin over the biliary stent (Cron prostheses). Ten weeks later, a Roux-en-Y hepaticojejunostomy was fashioned. The T-tube inserted at the time of operation was removed after two months. Four months later, the hepaticojejunostomy got stenosed resulting in dilatation of the intrahepatic ducts. The re-operation was considered highly challenging and a percutaneous radiological stenting was planned. Two Gianturco® prostheses, 5 cm long, 2 cm in diameter, were successfully placed using a percutaneous transhepatic route, one after the other, across the stenosis [Figure 1]. The outcome was favourable with gradual normalization of hepatic laboratory values, and normal calibre of intrahepatic ducts. Patient was successfully followed up at regular intervals with laboratory and ultrasound investigations for 5 years and showed no signs of obstructive biliopathy.

Bottom Line: Advances in interventional endoscopy and percutaneous techniques have made stenting a preferred treatment modality for the management of these strictures.We report successful 20 years of follow-up of a case of trans-hepatic metallic stenting (2 Gianturco(®) prostheses, 5 cm long, 2 cm in diameter) done for stenosed hepatico-jejunostomy anastomosis after laparoscopic CBD injury.Percutaneous transhepatic stenting and long-term placement of metallic stents need to be re-evaluated as a minimally invasive definitive treatment option for benign biliary strictures in patients with altered anatomy such as hepatico-jejunostomy or in whom re-operation involves high risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal and Endocrinal Surgery, IRCAD/EITS, University of Strasbourg, Strasbourg, France.

ABSTRACT
Laparoscopic cholecystectomy is still associated with a considerable rate of biliary injuries and related strictures. Advances in interventional endoscopy and percutaneous techniques have made stenting a preferred treatment modality for the management of these strictures. We report successful 20 years of follow-up of a case of trans-hepatic metallic stenting (2 Gianturco(®) prostheses, 5 cm long, 2 cm in diameter) done for stenosed hepatico-jejunostomy anastomosis after laparoscopic CBD injury. Percutaneous transhepatic stenting and long-term placement of metallic stents need to be re-evaluated as a minimally invasive definitive treatment option for benign biliary strictures in patients with altered anatomy such as hepatico-jejunostomy or in whom re-operation involves high risk.

No MeSH data available.


Related in: MedlinePlus