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Título del libro: Anastomoses: Types, Techniques/procedures, Clinical Outcomes And Complications
Título del capítulo: Bilioenteric anastomoses

Autores UNAM:
MIGUEL ANGEL MERCADO DIAZ;
Autores externos:

Idioma:

Año de publicación:
2013
Resumen:

Bilioenteric anastomoses (BEA) are a frequent surgical procedureperformed under different scenarios. The main objective of BEA is toallow adequate bile outflow into the gastrointestinal tract and preventfuture biliary strictures that will compromise adequate bile drainage,leading to repeated episodes of cholangitis, secondary biliary cirrhosisand death. Indications for this procedure include benign diseases(strictures of the biliary tract, iatrogenic bile duct injuries, choledochalcysts) and malignant diseases (pancreatic cancer and distalcholangiocarcinoma). Since Winiwaters' first description of a bilioentericreconstruction more than 100 years ago, major technical advances have occurred through time. Bilioenteric anastomoses can be classified asextra-hepatic and intra-hepatic, depending of the anatomical area of thebiliary tract used. Extra-hepatic anastomoses include choledochoduodenostomy,choledochojejunostomy, and hepatojejunostomy.Intra-hepatic anastomoses include hepaticojejunostomy (Hepp-Couinaud)and peripheral cholangiojejunostomy (Longmire-Sanford). The Hepp-Couinaud technique is the most frequently performed anastomosis. Thisapproach exposes the extra-hepatic course of the left hepatic duct andallows a wide anastomosis to a Roux-en-Y jejunal loop. The use of transanastomoticstents is no longer necessary and has limited indications.Complications of BEA include cholangitis, biliary fistula, intraabdominalabscesses and strictures. Long-term follow-up report excellentresults in 90% of the patients. Sixty-five percent of recurrent stricturesdevelop during the first 2 years and 80% during the first 5-years aftersurgery. In this chapter we present the most frequently BEA techniquesperformed, their complications and outcome. © 2013 Nova Science Publishers, Inc. All Rights Reserved.


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