Anatomical study of the intrahepatic biliary ducts. Parameters that guide the surgical approach in transplanting the left lobe of the liver.

INTRODUCTION: The techniques of split liver transplantation and transplanting organs from living donors require a thorough anatomical knowledge of biliary drainage, and this is an important factor in preventing complications. METHODS: forty-five human livers were used to perform this study. Measurements were made between the confluence of the right hepatic duct (RHD) and the left hepatic duct (LHD) and among the following structures: the venous ligament, the vertex of the confluence of the duct of segment II (DSll) and the duct of segment III (DSIII), the insertion of the duct of the segment I (DSI) and the duct of segment IV (DSIV). Then the distance between the vertex of the confluence of DSII and DSIII and the ligamentum venosum was checked. RESULTS: The LHD had less anatomical variation than the RHD. Four drainage patterns were established for the left lobe, and pattern l, in which the confluence of DSll and DSIII is to the left of the ligamentum venosum, is considered to be the most constant one. A single duct of the confluence of DSll and DSIII was found 1, 2 and 2.5 cm to the right of the ligamentum venosum in 65%, 80%, and 95% of the cases, respectively. CONCLUSION: It was possible to show evidence of four drainage patterns of the left anatomical lobe of the liver. Furthermore, it was possible to establish the ligamentum venosum as an anatomical reference for locating the confluences of the ducts of the left liver segments.

[Cholangiography: a routine procedure in elective cholecystectomy?]. / Cholangiographie: une opération de routine lors d'une cholécystectomie élective?

A prospective study to evaluate the selective or routine use of intraoperative cholangiography on elective cholecystectomy was performed. 178 patients were studied, listing criteria to explore the biliary tract with the cholangiography aspects. The criteria showing choledocholithiasis were the alkaline phosphatase and/or bilirubin increase, dilated common bile duct, large cystic duct, small stones and pancreatitis or jaundice on the past history. The patients were divided in 4 groups: 1) no criteria: 61 (34.3%); 2) one criterion: 53 (30%); 3) two criteria: 22 (12.3%); 4) more than two criteria: 42 (23.4%). The false-positive was 1.6% to the first group, 3.8% to the group 2 and 0% to the other groups. We concluded that the intraoperative cholangiography must be achieved on patients that have at least one choledocholithiasis criterion.

[Cholangiography: a routine test in elective cholecystectomy?]. / Cholangiographie: une opération de routine lors d'une cholécystectomie élective?

A prospective study to evaluate the selective or routine use of intraoperative cholangiography on elective cholecystectomy was performed. 178 patients were studied, listing criteria to explore the biliary tract with the cholangiographic aspects. The criteria showing choledocholithiasis were the alkaline phosphatase and/or bilirubin increase, dilated common bile duct, large cystic duct, small stones and pancreatitis or jaundice on the past history. The patients were divided in 4 groups: 1) No criteria: 61 (34.3%); 2) One criterion: 53 (30%); 3) Two criteria: 22 (12.3%); 4) More than two criteria: 42 (23.4%). The false-positive was 1.6% to the first group, 3.8% to the group 2 and 0% to the other groups. We concluded that the intraoperative cholangiography must be achieved on patients that have at least one choledocholithiasis criterion.

[Auxiliary drainage of the intraperitoneal course of transhepatic tubes in benign common bile duct stenosis]. / Drainage auxiliaire sur le parcours intrapéritoneal des tubes transhépatiques dans les sténoses bénignes de la voie biliaire principale.

The authors used Penrose drains around intraperitoneal portion of Silastic tubes to prevent subphrenic collections in transhepatic intubation. In 31 cases of benign stenosis of the biliary tree, this peritoneal drainage was employed in 18 and no collections were observed. In the other group, 3 patients developed subphrenic abscess. Even with a result not statistically significant (P less than 0.05), the authors consider the procedure useful in transhepatic intubation.