Author/Editor     Paquet, K-J; Lazar, A; Koussouris, P
Title     Iatrogenic injury of the bile duct: long-term results after repair of strictures by adapting triangle and butterfly plastic
Type     članek
Source     In: Markovič S, Gadžijev EM, Sojar V, editors. Book of lectures and abstracts of 3rd postgraduate course in hepatology and 3rd postgraduate course in hepatobiliary surgery; 1995 Jun 19-23; Ljubljana. Ljubljana: Faculty of medicine,
Publication year     1995
Volume     str. 189-203
Language     eng
Abstract     Form January 1, 1965 to January 1, 1990 230 iatrogenic bile duct stricture, mainly admitted from other hospitals were managed at the Department of Surgery University of Bonn and HEINZ-KALK-Hospital Bad Kissingen. Indications for operation were postoperative strictures in 155 (67.3%), obliterations of biliary digestive anastomoses in 56(24.3%) and direct lesions to the bile duct in l9(8.4%) cases. In 202 cases (88%) a hepaticojejunostomy using an adapting triangle plastic was performed, in 28 cases (12%) with a double adapting trianle plastic, the "socalled" butterfly plastic was performed. Up to December 31, 1981, double jejunal loop for hepaticojejunostomy with a side-to-side-anastomosis 30-40 cm under the hepaticojejunostomy and since January 1st 1982 a single jejunal loop according to Roux-en-Y with a minimum length of 40-50 cm was carried out. The liver biopsy taken in 95% of the cases demonstrated normal tissue in 7.3 cases. In hospital mortality was 5.8 percent (13 cases). Main cases of death were biliary peritonitis, hepatic failure and intraabdominal hemorrhage. 172 of the living patients (90%) could be followed up for at least one year up to more than 25 years, 70% of them more than five year. Severe late complication developed in ten patients (6%). Restenosis with necassity for reconstruction occured in five cases and was successfully performed in four. Secondary biliary cirrhosis with bleeding esophageal varices occured in another five cases and could be successfully managed by elective shuntoperation or endoscopic sclerotherapy. Thus, the long-term outcome after surgical repair of iatrogenic biliary stricture was very good in about 95% of the controlled cases. There were 24 late deaths (10.4 percent) incoherent to the underlying disease. 21 cases (9.1%) were lost to follow up. Comparison of preoperative and late postoperative biochemical investigations demonstrated a normalisation in more than 90% of all postoperatively investigated cases. (trunc.)
Descriptors     BILE DUCTS
IATROGENIC DISEASE
BILIARY TRACT SURGERY