A new biliary access technique for the long-term endoscopic management of intrahepatic stones |
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Authors: | José Eduardo Monteiro Cunha Paulo Herman Marcel C. C. Machado Sonia Penteado Fauze Maluf Filho José Jukemura Telésforo Bacchella Emílio E. Abdo |
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Affiliation: | Department of Gastroenterology, Surgical Division, S?o Paulo University Medical School, S?o Paulo, Brazil, BR
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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 |
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Keywords: | intrahepatic stones surgical treatment operative technique duodenojejunostomy endoscopic management |
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