Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery: an algorithmic approach.

摘要: AIM:To investigate injuries of anatomy variants hepatic duct confluence during hepatobiliary surgery and their impact on morbidity mortality these procedures. An algorithmic approach for the management is proposed. METHODS: During a 6-year period 234 patients who had undergone major were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy fistulography. RESULTS: Thirty (12.8%) developed leaks identified. Endoscopic stenting percutaneous drainage successful 23 with from liver cut surface. In rest seven confluence, biliary variations recognized stepwise therapeutic was considered. Conservative only 2 patients. Volume remnant functional reserve as well local sepsis used criteria either resection corresponding segment or construction biliary-enteric anastomosis. Two deaths occurred this group (mortality rate 28.5%). CONCLUSION: Management fistulae that are disconnected mainstream tree related injury extremely challenging. These have grave prognosis an early surgical procedure has be