Bile Duct Replacement in Hepatobiliary Surgery: A Systematic Review
Mehdi Boubaddi1, Chetana Lim1,2, Eric Savier1,3
1Assistance Publique, Hôpitaux de Paris, Sorbonne Université, Service de Chirurgie Hépato-biliaire et Transplantation Hépatique, Hôpital Pitié-Salpêtrière, Paris, France.
World Journal of Surgery
|September 24, 2025
Summary
Autologous venous grafts offer a promising alternative to Roux-en-Y hepaticojejunostomy for biliary reconstruction. While still under development, this technique shows potential for reducing complications in hepatobiliary surgery.
Area of Science:
- Hepatobiliary Surgery
- Surgical Innovation
- Biliary Reconstruction
Background:
- Roux-en-Y hepaticojejunostomy (RYHJ) is the standard for biliary continuity but carries risks of stricture and cholangitis.
- Current biliary replacement techniques using substitutes are in early stages of development (IDEAL framework Stage 2a).
Purpose of the Study:
- To review the literature on biliary replacement using vein grafts as autologous substitutes.
- To evaluate the potential of autologous venous grafts as an alternative to RYHJ.
Main Methods:
- Literature review focusing on the IDEAL framework stages for biliary replacement techniques.
- Analysis of studies using vein grafts and other substitutes for bile duct reconstruction.
Main Results:
- Thirteen patients underwent biliary replacement with autologous vein grafts, primarily for post-cholecystectomy or hepatectomy bile duct injury.
- No 90-day mortality was observed; morbidity was 15.4% (2/13 patients).
- Twelve patients survived to the last follow-up, indicating promising outcomes.
Conclusions:
- Autologous venous grafts represent a potential alternative to RYHJ in hepatobiliary surgery.
- Further development is needed for this technique to become a widely adopted standard of care.
