Biliary-enteric anastomosis by means of a single layer of serosubmucosal sutures without T-tube drainage

The difficult hepaticojejunostomy after pancreatic head resection: reconstruction with a T tube

BACKGROUND

After pancreatic head resection, bile leaks from a difficult hepaticojejunostomy secondary to a small or fragile common hepatic duct may be reduced by a T tube at the side of the anastomosis.

METHODS

A retrospective analysis of patients who underwent a difficult hepaticojejunostomy without or with a T tube was performed.

RESULTS

In 48% (55/114) of patients, a T tube was placed at the side of the hepaticojejunostomy; 52% (59/114) did not have a T tube. Bile leaks occurred in 12% (14/114) (9% [5/55] in patients with a T tube vs 15% [9/59] without a T tube, P = .316). Bile leaks were associated with mortality, abscess formation, hemorrhage, and sepsis. Seven percent (8/114) of patients required revisional laparotomy (2% [1/55] with a T tube vs 12% [7/59] without a T tube, P = .036). Mortality was not different between the groups. Minor T-tube-associated complications occurred in 15% (8/55) without major complications.

CONCLUSIONS

Augmentation of anastomosis with a T tube cannot prevent biliary leakage but does reduce the severity of bile leaks, resulting in less reoperations.

External metallic circle in microsurgical anastomosis of common bile duct

BACKGROUND

Biliary stricture development is one of the most serious problems following biliary tract surgery. Here, we present a new technique for biliary tract reconstruction with an external metallic circle, and the results of this new technique in a rat model.

METHODS

Twelve male Sprague-Dawley rats (250 to 300 g) were divided into two groups. After transection of the bile duct, standard bile duct reconstruction (without the metallic circle) was performed in group 1 and reconstruction with the external metallic (silver) circle was performed in group 2. At the end of the fourth month, clinical, laboratory biochemical, and histopathologic parameters were compared between the groups.

RESULTS

Serum concentrations of alkaline phosphatase (ALP) and operation time were higher in group 1 than in group 2. Differences were statistically significant. In histopathologic examination, biliary duct stricture was seen in group 1. Foreign body reaction and fibrosis in the bile duct wall were seen in group 2.

CONCLUSION

An external metallic circle prevents development of biliary stricture after primary end-to-end bile duct anastomosis in this rat model.