Portoenterostomy: an old treatment for a new disease

HYPOTHESIS: Portoenterostomy may be an effective treatment for patients sustaining a thermal injury to the hepatic duct confluence during laparoscopic cholecystectomy. DESIGN: Case series. SETTING: A tertiary care referral hospital. PATIENTS: A consecutive series of 5 female patients referred and treated between November 13, 1991, and December 17, 1998. Ages ranged from 29 to 65 years. In addition to the ductal injuries at or above the hepatic duct confluence, 3 patients also had a major hepatic vascular injury. The patients were available for follow-up for 7 to 91 months postoperatively. INTERVENTIONS: All patients underwent a portoenterostomy (Kasai procedure) with suturing of a Roux limb to the hepatic tissue surrounding the transected hepatic ducts. Transhepatic stents were inserted either preoperatively or postoperatively for rising liver enzyme levels in 4 patients. MAIN OUTCOME MEASURES: Symptoms and results of liver function tests. RESULTS: Stents remained in place for 9 to 25 months in 4 patients. All 5 patients were symptom free and functioning normally; 3 had normal liver functions; 2 had mildly elevated alkaline phosphatase levels only. CONCLUSION: Portoenterostomy, usually in combination with postoperative stenting, may be an option to consider in life-threatening injuries involving the hepatic duct bifurcation in which standard biliary reconstruction techniques are not feasible.