21yr female underwent reduced port Lap chole in her Home town,post operatively she developed large Biloma which was drained by percutanious pig tail cathter elsewhere,now the bile out put is 500mls in 24 hours.MRCP -Strausbergh E2 .she is Apyrexial ,not toxic,LFT were abnormal.4 weeks post op,no jaundice,As expected R and L hepatic ducts are non dilated and junction looks intact.Shell we reconstruct now or wait till the ducts dilate.
Well, unless the biliary leak will remain i think that you'r not gonna see any BD dilatation. Unless the output is stable and patient shows no signs of sepsis, in my opinion, you should perform an hepaticojejunal anastomisis as soon as you can
In cases like this one I prefer to go ahead and perform a hepatico jejunostomy
Thankyou,pt had undergone ERCP, fortunately it was not complete hence both ducts were stented and adviced change of stents in 3 months ,subsequently 4 to 5 sessions.Assess at each time and proceed.
Bile duct injury complicated with biliary fistula usually evolve to a biliary stricture. Roux-en-Y hepaticojejunostomy gained the most wide acceptance as method of choice for reestablishing biliary drainage to the digestive tube. So I think that hepaticojejunostomy can be performed, but the risk of re-stenosis is high due to local inflammatory ongoing alterations provoked by the continuous bile leak.
If endoprothesis failed ,Roux Y anastomosis is the best choice with few risk of re-stenosis
Many years ago we published a modified procedure to decrease the stenosis rate ater hepatic jejunostomy . " A modified technique for surgical repair of cicatricial stenosis of the bile duct. Machado MC, da Cunha JE, Bacchella T. Surg Gynecol Obstet. 1986 Mar;162(3):282-4. PMID: 3513350 " This technique aims to reduce the blood flow compromising during the dissection of biliary duct to perform the anastomosis
I think that ERCP stanting is the best choise. But first of all it's interesting to see the MRCP. Is it possible?
first session of stent exchange was done a month ago,very good result and adviced restenting again 3 months later,
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