Laparoscopic repair of left hepatic duct stenosis using the pedicled umbilical vein patch for hepatolithiasis (with videos)

Although transjugular intrahepatic portosystemic shunts are most frequently used for the management of portal hypertension, the surgical approach is preferred for symptomatic portal cavernoma cholangiopathy. We present the case of a 25-year old female patient with a portal cavernoma secondary to catheterization of the umbilical vein at birth. She had had two episodes of esophageal variceal bleeding, successfully treated by endoscopic banding. and an episode of acute cholangitis secondary to portal cavernoma cholangiopathy. Endoscopic sphincterotomy and biliary stenting were performed, and were followed by repeated episodes of biliary stent occlusion. The last biliary drainage procedure triggered a massive hemobilia. Since endoscopic therapy was ineffective, a surgical mesocaval shunt with graft interposition and splenectomy was performed with favorable outcome. In selected cases, the mesocaval shunting plays an essential role in the treatment of portal cavernoma cholangiopathy even in the era of interventional radiology. Abbreviations: CBD: common bile duct; CT: computed tomography; ERCP: endoscopic retrograde cholangiopancreatography; IVC: inferior vena cava; LHD: left hepatic duct; MRCP: magnetic resonance cholangiopancreatography; PC: portal cavernoma; PCC: portal cavernoma cholangiopathy; SMV: superior mesenteric vein.

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Blunt left hepatic duct injury

Injury ◽

10.1016/0020-1383(94)90274-7 ◽

1994 ◽

Vol 25 (7) ◽

pp. 465-467 ◽

Cited By ~ 5

Author(s):

F.D. Brenneman ◽

S.B. Rizoli ◽

B.R. Boulanger ◽

S.S. Hanna

Keyword(s):

Hepatic Duct ◽

Left Hepatic Duct

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EXPERIENCE OF EVALUATION OF PATIENTS OF OBSTRUCTIVE JAUNDICE BY SONOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AT A TERTIARY CARE CENTRE IN EASTERN INDIA

10.36106/ijar/7914686 ◽

2021 ◽

pp. 61-64

Author(s):

Santosh Kumar Prasad ◽

Nupur Nupur ◽

Akshit Pathak ◽

Indra Shekhar Thakur ◽

Vijay Shankar Prasad

Keyword(s):

Magnetic Resonance ◽

Obstructive Jaundice ◽

Hepatic Duct ◽

Tertiary Care ◽

Pancreatic Head ◽

Magnetic Resonance Cholangiopancreatography ◽

Stricture Formation ◽

Tertiary Care Centre ◽

Left Hepatic Duct ◽

Cross Sectional

INTRODUCTION: Jaundice means yellow due to the yellowish discolouration of skin, sclera, and mucous membrane seen in jaundice caused by bilirubin pigment. It is divided in to two forms obstructive(surgical) and non- obstructive (non-surgical). AIM AND OBJECTIVE: To evaluate patients of obstructive jaundice by sonography and magnetic resonance cholangiopancreatography and compare the reporting and ndings by both the modalities. MATERIALS AND METHODS: Cross sectional observational study done from November 2018 to October 2020 and consists of 32 patients who had clinical jaundice and consented to being subjected to both ultrasound and MRCP. OBSERVATIONS:Both USG and MRCP were able to detect extrahepatic CBD dilatation equally in 25 patients. In 5(15.6%) patients USG and MRI both demonstrated intrahepatic mass causing obstruction at the level of conuence of right and left hepatic duct or CHD. Ultrasonography was able to detect the intrinsic mass of the extrahepatic common bile duct in 2(6.2%) patients out of 32 patients in our study population. MRCP could detect the same in 6(18.7%) patients. In our study narrowing of CBD with stricture formation and upstream dilatation of biliary tree was identied in 10(31.2%) patients on MRCP. Ultrasound could diagnose the same in one patient. Both USG and MRCP were able to detect pancreatic head mass as well as pseudocyst. CONCLUSION: The accuracy of MRCP was found to be comparable to that of ERCP for diagnosis of etiology for obstructive jaundice. MRCP allows better lesion characterization and assessment. However, the patchy availability of MR machines become the main achilles heel for the surgeons as well as the radiologists. Hence the valuable role of the omnipresent ultrasonography become immense.

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Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

Anatomy Research International ◽

10.1155/2012/838179 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Theodoros Mariolis-Sapsakos ◽

Vasileios Kalles ◽

Konstantinos Papatheodorou ◽

Nikolaos Goutas ◽

Ioannis Papapanagiotou ◽

...

Keyword(s):

Bile Ducts ◽

Hepatic Duct ◽

Anatomical Variations ◽

Common Hepatic Duct ◽

Drainage Pattern ◽

Left Hepatic Duct ◽

Surgical Interventions ◽

Drainage Patterns ◽

The Common ◽

The Right

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

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Laparoscopic Approach to Left Hepatectomy Using a Standardized Technique

10.47363/jghr/2021(2)116 ◽

2021 ◽

pp. 1-3

Author(s):

Chang Stephen Kin Yong ◽

◽

R Ang ◽

Keyword(s):

Surgical Technique ◽

Traditional Approach ◽

Hepatic Duct ◽

Laparoscopic Hepatectomy ◽

Vena Cava ◽

Laparoscopic Approach ◽

Liver Parenchyma ◽

Left Hepatic Duct ◽

Patient Selection Criteria ◽

Key Steps

Introduction: The laparoscopic approach in liver surgery has been preferred over the traditional approach in the resection of segments 2 and 3, as laparoscopic surgical technique can be standardized for easy adoption and is minimally invasive. This paper describes the laparoscopic surgical technique and recommends the patient selection criteria in the resection of segments 2, 3 and 4. Methods: This technique involves 2 key steps – early division of the left pedicle before the division of the liver parenchyma and the placement of an instrument beneath the transection plane to simulate a ‘hanging manoeuvre’ with reduced blood loss and allows the expeditious division of the liver parenchyma. Apart from the usual contraindications to liver resections, specific contraindications to this technique include patients with aberrant biliary drainage of right liver segments into the left hepatic duct, patients with tumours abutting the hilar plate and patients with tumours located near the junction of the left hepatic vein and the vena cava. Conclusion: The authors recommend these steps to serve as a standardized technique for laparoscopic hepatectomy of segments 2,3 and 4 in selected patients, allowing the learning curve for this technique to be markedly shortened

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Percutaneous transhepatic biliary drainage: Alternatives in left hepatic duct obstruction

Gastrointestinal Radiology ◽

10.1007/bf01889178 ◽

1989 ◽

Vol 14 (1) ◽

pp. 137-142 ◽

Cited By ~ 8

Author(s):

Renan Uflacker ◽

Guilherme S. Mourão ◽

Ronie L. Piske ◽

Sergio Lima

Keyword(s):

Biliary Drainage ◽

Percutaneous Transhepatic Biliary Drainage ◽

Hepatic Duct ◽

Left Hepatic Duct ◽

Duct Obstruction ◽

Transhepatic Biliary Drainage

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When It Doesn't Fit: Congenital Anomalies of the Choledochus

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0039-1693998 ◽

2020 ◽

Vol 08 (01) ◽

pp. e86-e89

Author(s):

Helena Reusens ◽

Mark Davenport

Keyword(s):

Case Report ◽

Bile Duct ◽

Common Bile Duct ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Resected Specimen ◽

Cystic Dilatation ◽

Left Hepatic Duct ◽

Distal Common Bile Duct

Abstract Introduction Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1–5) are recognized in Todani's classification and its modifications, of which types 1 and 4 typically have an associated anomalous pancreatobiliary junction and common channel (CC). We describe two cases with previously undescribed features. Case Report 1 Antenatal detection of a cyst at porta hepatis was made in an otherwise normal girl of Iranian parentage. She was confirmed to be a CCM (20 mm diameter), postnatally, with no evidence of obstruction. Surgical exploration was performed at 12 weeks. She had an isolated cystic dilatation of the right-hepatic duct only. The left-hepatic duct and common bile duct (CBD) were normal without a CC. Histology of the resected specimen showed stratified squamous epithelium. Case Report 2 A preterm (31 weeks of gestation) boy of Nigerian parentage was presented. His mother was HIV + ve and he was treated with nucleoside reverse transcriptase inhibitors following birth. He had persistent cholestatic jaundice and a dilated (10 mm) bile duct from birth. Although the jaundice resolved, the dilatation persisted and increased, coming to surgery aged 2.5 years. This showed cystic dilatation confined to the common hepatic duct, and otherwise normal distal common bile duct and no CC. Result Both underwent resection with the Roux-en-Y hepaticojejunostomy reconstruction to the transected right-hepatic duct alone in case 1, leaving the preserved left duct and CBD in continuity, and to the transected common hepatic duct in case 2. Conclusions Neither choledochal anomaly fitted into the usual choledochal classification and case 1 appears unique in the literature.

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Extended Right Hepatectomy with Total Caudate Lobe Resection and Biliary Tree Resection for a Large Colorectal Liver Metastasis Involving both the Right and Left Hepatic Lobes and the Umbilical Fissure: A Case Report

The American Surgeon ◽

10.1177/000313480507100517 ◽

2005 ◽

Vol 71 (5) ◽

pp. 447-449 ◽

Cited By ~ 1

Author(s):

Aljamir D. Chedid ◽

Marcio F. Chedid ◽

Cleber R.P. Kruel ◽

FÁbio M. Girardi ◽

Cleber D.P. Kruel

Keyword(s):

Colorectal Cancer ◽

Bile Duct ◽

Liver Metastasis ◽

Liver Tumors ◽

Hepatic Duct ◽

Early Death ◽

Caudate Lobe ◽

Right Hepatectomy ◽

Left Hepatic Duct ◽

Extended Right Hepatectomy

Very large right-sided liver tumors may grow up to the base of the umbilical fissure and involve the left hepatic duct and can occasionally reach the bile duct confluence. This kind of involvement has often been considered a contraindication to resection. We report a patient who presented with a large hepatic metastasis from colorectal cancer that reached the umbilical fissure and involved the left hepatic duct just above the bile duct confluence. An extended right hepatectomy including complete resection of caudate lobe was performed. We resected the left and common hepatic ducts, as well as both the entire hepatic and the proximal third of common bile duct. A long jejunal limb Roux-en-Y (45 cm) single-layer left intrahepatic hepaticojejunostomy was constructed. She is still well 14 months postoperatively. To the best of our knowledge, this is the first report of such a procedure employed for the treatment of a liver metastasis from colorectal cancer. Extended right hepatectomy including complete caudate lobe resection can be feasible even when the majority of the extrahepatic biliary system needs to be resected. Our approach probably offers the only chance to prevent early death from liver failure in these patients.

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