Hepaticoduodenostomy in Hepatectomy for Perihilarcholangiocarcinoma: A Preliminary Report

Surgical Technique

Austin J Surg. 2014;1(3): 1012.

Hepaticoduodenostomy in Hepatectomy for Perihilarcholangiocarcinoma: A Preliminary Report

Hiroshi Yoshida1*, Yasuhiro Mamada2, Nobuhiko Taniai2, Hiroshi Makino1, Tadashi Yokoyama1, Hiroshi Maruyama1, Atsushi Hirakata1, Masahiro Hotta1 and Eiji Uchida2

1Department of Surgery, Nippon Medical School Tama Nagayama Hospital, Japan

2Department of Surgery, Nippon Medical School, Japan

*Corresponding author: Hiroshi Yoshida, Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1, Nagayama, Tama-city, Tokyo, 206-8512, Japan

Received: February 08, 2014; Accepted: April 18, 2014; Published: April 21, 2014

Abstract

A Roux–en–Y anastomosis fashioned from the jejunum (i.e., hepaticojejunostomy) is usually used to reconstruct the biliary system in hepatectomy. In this study, we review our experience with hepaticoduodenostomy (HD) as an alternative to Roux–en–Y biliary anastomosis in patients undergoing hepatectomy for perihilarcholangiocarcinoma, report our preliminary findings in 2 patients, and speculate on future applications. Laparotomy was performed using a Kent retractor. Wide kocherization of the duodenum was done to provide a tension–free anastomosis to the hepatic duct. The Kent retractor was released transiently, and the anastomosis was confirmed to be free of tension. Hepatectomy and excision of the common bile duct were performed. In patients with short distances between the hepatic ducts, a hepaticoplasty was performed. A 10–Fr silicon drain with channels along the sides, approximately 20 mm in length, was used as an internal stent. HD was performed with a single–layer anastomosis with continuous sutures. No complication occurred after HD. Our initial experience suggests that HD may be a viable alternative to Roux–en–Y biliary anastomosis in patients undergoing hepatectomy for perihilarcholangiocarcinoma.

Keywords: Hepaticoduodenostomy; Hepatectomy; Perihilarcholangiocarcinoma

Introduction

A Roux–en Y anastomosis fashioned from the jejunum (i.e.,hepaticojejunostomy [HJ]) is usually used to reconstruct the biliary system in patients undergoing hepatectomy for perihilarcholangiocarcinoma [1]. Recently, reconstruction by hepaticoduodenostomy (HD) or choledochoduodenostomy has been recommended instead of reconstruction by HJ or choledochojejunostomy [2–14]. Complications such as biliary leakage and cholangitis are well documented after HJ and choledochojejunostomy [15–19]. Moreover, the biliary tree is difficult to access endoscopically in patients undergoing enteric reconstruction using a Roux–en–Y anastomosis to the jejunum [20]. HD offers the possible advantage of simple postoperative access to the biliary system by endoscopy and avoids the complications associatedwith HJ [2].

In this study, we review our experience with HD as an alternative to Roux–en–Y biliary anastomosis in patients undergoing hepatectomy for perihilarcholangiocarcinoma, report our preliminary findings in 2 patients, and speculate on future applications.

Case 1

A 74–year–old woman was admitted because of a dilated left intrahepatic bile duct. Previously, she had undergone a right colectomy because of colonic carcinoma. However, minor leakage of the anastomosis occurred, and reoperation (drainage) was performed.After that, ileus developed and reoperation was done again. Computed tomography revealed dilatation of the left intrahepatic bile duct and mild dilatation of the right posterior intrahepatic duct (Figure 1). Drip infusion cholangiography revealed only the right anterior intrahepatic duct and stenosis at the hepatic hilum (Figure 2). Perihilarcholangiocarcinoma was diagnosed.