ANASTOMOSIS BILIOENTERICA PDF
Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results. Postoperative bilioenteric anastomotic strictures are encountered in a significant number of patients after primary biliary repair, hepatopancreaticobiliary tumor. access to the bilioenteric anastomosis and thus to the hepatobiliary tree for non- operative management of chronic and recurrent biliary tract.
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Other Sections Abstract Introduction Diagnosis Percutaneous Dilation Procedural Variables Complications Treatment Success and Failure Peri-Procedural Management and Longitudinal Follow-up Emerging Techniques and Future Directions Conclusion Figures Tables References Abstract Postoperative bilioenteric anastomotic strictures are encountered in a significant number of patients after primary biliary repair, hepatopancreaticobiliary tumor resection, and liver transplantation. Sign in to access your subscriptions Sign in to your personal account.
D Completion cholangiogram showing resolution of the stricture post stent removal. Purchase access Subscribe to the journal.
Certain technical aspects must also be mentioned when using cutting balloons. Ahrendt, MD ; Henry A. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. As with dilation procedures elsewhere in the body, high-pressure low-compliance balloons are typically used for biliary stricture dilation.
Of the most recent larger trials, Vos et al 20 used the smallest catheters 8. To date, anaxtomosis specific procedural factor has been associated with a significant increase or decrease in complication rate. Biodegradable biliary stent implantation in the treatment of benign bilioplastic-refractory biliary strictures: Contraindications to balloon dilation include massive ascites, a shrunken cirrhotic liver which cannot be accessed safely i.
Proponents of short-term stenting up to one month argue equivalent efficacy with less inconvenience to the patient. Incidence and outcome of biliary strictures after wnastomosis. Factors influencing outcome in patients with postoperative biliary strictures. An 18 F silicone biliary catheter with 6.
A history of the bilioenteric anastomosis.
Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation. Coronal magnetic resonance cholangiopancreatography MRCP -echoplanar fast spin echo sequence showing focal filling defect at the hepaticojejunostomy in a year-old female with jaundice 3 months after robotic pancreaticoduodenectomy.
Biliary tract, Constriction, anastomodis, Radiology, interventional, Stents. Due to difficulties with repeat surgery and endoscopic access, percutaneous dilation has become the accepted treatment in these cases.
Potential complications of retrievable stents include migration, side branch occlusion, and stent degradation with subsequent difficulty of removal. At our institution the balloon is expanded to its rated pressure in a gradual fashion, with use of a larger diameter balloon or possibly cutting balloon should the current balloon prove insufficient to dilate the stricture.
Eur J Gastroenterol Hepatol. C A percutaneous wire has been advanced into the afferent jejunal limb and grasped by the endoscope. Dissolvable stents Dissolvable stents made from polydioxanone Fig.
Case reports by Kakani et al 33 and Sheridan and Maclennan 34 have shown successful treatment using cutting balloons without the need for catheter stenting, and have shown continued patency for 10 months and 3 years respectively. Indeed, cutting balloons are often used at our own institution with good result Fig.
Some protocols bilioetnerica sequential stricture dilation with catheters, rather than balloon inflation, as the main mechanism of treatment. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures anasromosis by endoscopic stent placement.
In situations when this approach is unusable, techniques for percutaneous stent retrieval also exist. Peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures: The benefits of paclitaxel-coated stents are well established in treating vascular stenosis. Drug eluting biliary stents to decrease stent failure rates: Biluoenterica protocol is similar to that used by Schumacher et al 28 and Weber et al, 14 with treatment failure rates of Before performing percutaneous balloon dilation, a full biochemical laboratory analysis including complete blood count, comprehensive metabolic profile including a liver panel, and a coagulation profile should be obtained.
A history of the bilioenteric anastomosis.
Overnight observation is suggested when a new percutaneous access is being placed. This requires adequate patient education anatomosis motivation. Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more.
First, because of the embedded blades, caution must be taken by the operator when handling the balloon catheter outside of the patient. Percutaneous management of postoperative anastomotic biliary strictures.
N Engl J Med. Ann R Coll Surg Engl. The current review aims to discuss various treatment protocols and their relative efficacy, as well as touch on emerging techniques.
Long-term safety and efficacy of drug-eluting versus bare-metal stents in Sweden. Long-term results of metallic stents for benign biliary strictures. Once stenting has been maintained for longer than 1 year without desired clinical result, treatment is unlikely to be successful.
Catheter-based upsizing Some protocols use sequential stricture dilation with catheters, rather than balloon inflation, as the main mechanism of treatment. This is especially important if the patient is actively cholangitic, as manipulation of a fresh intraparenchymal tract increases the exposure of hepatic venous blood to bile, with resultant increased risk of bilioenyerica.
Transhepatic balloon dilation of annastomosis strictures in liver transplant patients: Stent duration and repeat dilation Once the stent catheter has been placed, it has to be maintained long enough that the ballooned stricture has time to heal around it. The medical charts of patients with biliary complications after OLT during a year periodwho failed to respond to nonsurgical treatment and were surgically treated, were reviewed.