A new biliary access technique for the long-term endoscopic management of intrahepatic stones |
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Authors: | Monteiro Cunha José Eduardo Herman Paulo Machado Marcel C C Penteado Sonia Filho Fauze Maluf Jukemura José Bacchella Telésforo Abdo Emílio E |
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Institution: | Department of Gastroenterology, Surgical Division, S?o Paulo University Medical School, S?o Paulo, Brazil. |
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Abstract: | Intrahepatic stone disease poses a difficult postoperative management problem due to frequent stone recurrence. Most of the
methods proposed for long-term access to the intrahepatic biliary tree require multiple sessions of additional, usually invasive,
procedures. An alternative method for endoscopic long-term access to the intrahepatic ducts, represented by a side-to-side
anastomosis between the isolated Roux-en-Y jejunal limb of the bilioenteric bypass and the duodenum (duodenojejunostomy),
was used in eight patients with retained and/or recurrent stones after surgical treatment of intrahepatic stone disease. There
were no short- or long-term complications or mortality associated with the duodenojejunostomy. Postoperative endoscopic access
to the intrahepatic ducts was successfully achieved in five of six patients: one with stone recurrence, one with a left hepatic
duct stricture and stone recurrence and one with known retained postoperative stones. In two patients, no stones were found
at endoscopy. Side-to-side duodenojejunostomy may be useful in the long-term endoscopic management of recurrent intrahepatic
biliary stone disease and should be indicated whenever a bilioenteric anastomosis is performed for the treatment of bilateral
intrahepatic stone disease.
Introduction
Received: August 16, 2001 / Accepted: February 8, 2002 |
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Keywords: | Intrahepatic stones Surgical treatment Operative technique Duodenojejunostomy Endoscopic management |
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