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Atraumatic method of intraoperative retrograde transhepatic biliary stent insertion
E R Sauter1, J P Hoffman, W H Hartz
1Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Journal of Surgical Oncology
|May 1, 1996
Summary
A novel technique for intraoperative retrograde transhepatic stenting (IRTS) minimizes hepatic injury risk. This atraumatic method shows acceptable morbidity and mortality, offering a viable alternative for surgeons.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Intraoperative retrograde transhepatic stenting (IRTS) carries a significant risk of hepatic injury.
- Existing IRTS methods necessitate careful consideration to mitigate potential complications.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel, atraumatic IRTS technique.
- To minimize hepatic injury during IRTS by modifying stent placement and diameter.
Main Methods:
- A pliable sheath was used to create a stent tract conforming to the biliary tree's natural curve.
- Stent diameter was decreased, and the hepatic hilum was avoided during insertion.
- The technique was applied to 24 patients undergoing IRTS between 1992 and 1995.
Main Results:
- No operative mortality was observed.
- Operative morbidity was 38%, with all complications readily treated and primarily due to stent dislodgment.
- No deaths occurred, and complications related to stent insertion were minimal.
Conclusions:
- The novel atraumatic IRTS method demonstrates acceptable morbidity and mortality rates.
- This technique offers a viable and safer alternative to traditional IRTS when transhepatic stenting is required.
- Securely anchoring the stent to the skin is crucial to prevent dislodgement and associated complications.