[Hepaticojejunostomy after pancreatic head resection - technical aspects for reconstruction of small and fragile bile ducts with T-tube drainage]. / Die Technik der Hepatikojejunostomie mit T-Drainage bei der Rekonstruktion schmalkalibriger Gallengänge nach Pankreaskopfresektion.
Zentralbl Chir
; 137(6): 559-64, 2012 Dec.
Article
en De
| MEDLINE
| ID: mdl-23264197
ABSTRACT
BACKGROUND:
After pancreatic head resection the reconstruction of small and fragile bile ducts is technically demanding, resulting in more postoperative bile leaks. One option for the reconstruction is the placement of a T-tube drainage at the site of the anastomosis. MATERIAL ANDMETHODS:
Standard reconstruction after pancreatic head resection was an end-to-side hepaticojejunostomy with PDS 5.0, 15-25 cm distally from the pancreaticojejunostomy. For patients with a small bile duct diameter (≤ 5 mm) or a fragile bile duct wall the reconstruction was performed with PDS 6.0 and a T-tube drainage at the side of the anastomosis.RESULTS:
The reconstruction with a T-tube drainage at the site of the anastomosis is technically easy to perform and offers the opportunity for immediate visualisation of the anastomosis in the postoperative period by application of water soluble contrast medium. If a bile leak occurs, biliary deviation through the T-tube drainage can enable a conservative management without revisional laparotomy in selected patients. Whether or not a conservative management of postoperative bile leaks will lead to more bile duct strictures is a subject for further investigations.CONCLUSION:
A T-tube drainage at the site of the anastomosis can probably not prevent postoperative bile leaks from a difficult hepaticojejunostomy, but in selected patients it offers the opportunity for a conservative management resulting in less re-operations. Therefore we recommend the augmentation of a difficult hepaticojejunostomy with a T-tube drainage.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Pancreatectomía
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Complicaciones Posoperatorias
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Colestasis Extrahepática
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Anastomosis Quirúrgica
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Yeyunostomía
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Drenaje
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Fístula Biliar
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Conductos Biliares Extrahepáticos
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Implantación de Prótesis
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Risk_factors_studies
Límite:
Female
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Humans
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Male
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Middle aged
Idioma:
De
Año:
2012
Tipo del documento:
Article