Laser-guided repair of complex bile duct strictures.

Abstract:

BACKGROUND:The repair of bile duct strictures (BDS) requires identification of healthy bile duct proximal to the stenosis. Identification may be difficult in complex bile duct injuries after cholecystectomy or partial liver resection. AIM:We describe a technique to identify the prestenotic bile duct using the sentinel light of a laser fiber passed through the catheter after percutaneous transhepatic biliary drainage (PTD). METHODS:Seven patients were seen with hepatic duct or segmental BDS after (extended) right hemihepatectomy (4), cholecystectomy (2) or previous hepaticojejunostomy (1). All patients underwent preoperative PTD for imaging of stricture site and drainage. During operation for repair, a laser fiber (0.2-0.6 mm) connected to a (low-power) red light-emitting diode laser was passed through the PTD catheter into the proximal end of the stricture. RESULTS:In 6 patients, the prestenotic bile duct was identified and exposed with the aid of the sentinel light of the laser fiber. Roux-en-Y hepaticojejunostomy was carried out in all patients. Postoperative cholangiographies showed complete restoration of biliary continuity. In one patient, positioning of the laser fiber failed because of angulation of the PTD catheter. CONCLUSION:Laser-guided identification of prestenotic bile duct facilitates exposure of the stricture site without unnecessary and usually difficult dissection in complex postoperative BDS.

journal_name

Dig Surg

journal_title

Digestive surgery

authors

van Gulik T,Beek J,de Reuver P,Aronson D,van Delden O,Busch O,Gouma D

doi

10.1159/000227276

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

358-63

issue

5

eissn

0253-4886

issn

1421-9883

pii

000227276

journal_volume

26

pub_type

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