Buttressing hepaticojejunostomy's with hepatic round ligament flap may be beneficial

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Buttressing hepaticojejunostomy's with hepatic round ligament flap may be beneficial

Journal Title: Polish Journal of Surgery - Year 2017, Vol 89, Issue 4

Abstract

Background: Bile leaks and anastomotic strictures are important complications of hepaticojejunostomy (HJ). Evidence suggests that the use of hepatic round ligament (HRL) to buttress HJ may be beneficial. This study evaluates the feasibility of this approach. Methods: HJs performed over 2 years (Jun 2014- May 2016), with HRL reinforcement, were analyzed. Operative outcomes measured included technical difficulty, blood loss, time necessary for flap harvest, and reinforcement of HJ. The postoperative outcomes measured were the presence of bile leak and anastomotic stricture. Results: Forty-one patients (27 M: 14 F), aged 2-79 years, median age of61 years, underwent HJ with HRL buttress; 27 for periampullary/ head of the pancreas carcinoma; 4 for choledochal cysts; 4 for chronic pancreatitis; 3 for gallbladder carcinoma; 3 for benign biliary stricture. The time for harvesting HRL flaps and buttressing HJ was <10 minutes. No blood was lost during harvesting the flaps. One patient (2.5 %) had grade A leak following radical cholecystectomy, and structures were not observed during a median follow-up of 18 months (6 months to 2years). Conclusion: HRL-based buttressing of HJ can reduce the bile leak and/or stricture rate.<br/><br/>

Authors and Affiliations

Jayant Kumar Banerjee, Ramanathan Saranga Bharathi, Pankaj Purushotam Rao

Keywords

Hepatic round ligament/ ligamentum teres hepatis; Bilioenteric anastomosis; Hepaticojejunostomy; Bile leak; Anastomotic stricture; Autologous hepatic round ligament flap

EP ID EP218433
DOI 10.5604/01.3001.0010.3901
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