Biliary reconstruction in benign postoperative stricture with transhepatic tubes

Area of Science:

• Hepatobiliary surgery
• Surgical reconstruction techniques
• Gastrointestinal tract procedures

Background:

• Iatrogenic lesions of the main biliary tract are serious complications requiring surgical repair.
• Effective biliary reconstruction techniques are crucial for patient recovery and long-term outcomes.
• Previous methods have varying success rates and complication profiles.

Purpose of the Study:

• To report the experience and outcomes of biliary reconstructions using the Hepp and Couinaud technique with transhepatic Silastic tubes.
• To evaluate the efficacy of a specific surgical approach for managing iatrogenic bile duct injuries.
• To assess the long-term results and complications associated with this reconstructive method.

Main Methods:

• Retrospective analysis of 31 patients undergoing biliary reconstruction for iatrogenic main biliary tract lesions.
• Application of the Hepp and Couinaud technique in 90% of cases, utilizing transhepatic Silastic tubes for a recommended 6-month duration.
• Use of Penrose drains to protect transhepatic tube exit sites and prevent subphrenic fluid collection.

Main Results:

• The Hepp and Couinaud technique with transhepatic Silastic tubes was employed in the majority of patients.
• Immediate postoperative mortality was 9%.
• Long-term follow-up (mean 44 months) showed good results in 92% of surviving patients.

Conclusions:

• The Hepp and Couinaud technique, augmented by transhepatic Silastic tubes and protective Penrose drains, is an effective method for biliary reconstruction after iatrogenic injuries.
• This approach demonstrates a high success rate with acceptable short-term and long-term outcomes.
• Minimizing complications like subphrenic fluid collection is achievable with specific procedural modifications.