Buttressing hepaticojejunostomy's with hepatic round ligament flap may be beneficial

2017 ◽  
Vol 89 (4) ◽  
pp. 5-10 ◽  
Author(s):  
Jayant Kumar Banerjee ◽  
Ramanathan Saranga Bharathi ◽  
Pankaj Purushotam Rao
Keyword(s):  
Anastomotic Stricture ◽  
Bile Leak ◽  
Technical Difficulty ◽  
Round Ligament ◽  
Pancreas Carcinoma ◽  
Operative Outcomes ◽  
Stricture Rate ◽  
Anastomotic Strictures ◽  
Head Of The Pancreas

Background: Bile leaks and anastomotic strictures are important complications of hepaticojejunostomy (HJ). Evidence suggests that the use of hepatic round ligament (HRL) to buttress HJ may be beneficial. This study evaluates the feasibility of this approach. Methods: HJs performed over 2 years (Jun 2014- May 2016), with HRL reinforcement, were analyzed. Operative outcomes measured included technical difficulty, blood loss, time necessary for flap harvest, and reinforcement of HJ. The postoperative outcomes measured were the presence of bile leak and anastomotic stricture. Results: Forty-one patients (27 M: 14 F), aged 2-79 years, median age of61 years, underwent HJ with HRL buttress; 27 for periampullary/ head of the pancreas carcinoma; 4 for choledochal cysts; 4 for chronic pancreatitis; 3 for gallbladder carcinoma; 3 for benign biliary stricture. The time for harvesting HRL flaps and buttressing HJ was <10 minutes. No blood was lost during harvesting the flaps. One patient (2.5 %) had grade A leak following radical cholecystectomy, and structures were not observed during a median follow-up of 18 months (6 months to 2years). Conclusion: HRL-based buttressing of HJ can reduce the bile leak and/or stricture rate.

scholarly journals Outcomes of the Use of Fully Covered Esophageal Self-Expandable Stent in the Management of Colorectal Anastomotic Strictures and Leaks

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Chad J. Cooper ◽  
Angel Morales ◽  
Mohamed O. Othman
Keyword(s):  
Anastomotic Leak ◽  
Clinical Success ◽  
Anastomotic Stricture ◽  
Clinical Success Rate ◽  
Stent Migration ◽  
Metal Stents ◽  
The Novel ◽  
Anastomotic Leaks ◽  
Anastomotic Strictures

Introduction. Colorectal anastomotic leak or stricture is a dreaded complication leading to significant morbidity and mortality. The novel use of self-expandable metal stents (SEMS) in the management of postoperative colorectal anastomotic leaks or strictures can avoid surgical reintervention. Methods. Retrospective study with particular attention to the indications, operative or postoperative complications, and clinical outcomes of SEMS placement for patients with either a colorectal anastomotic stricture or leak. Results. Eight patients had SEMS (WallFlex stent) for the management of postoperative colorectal anastomotic leak or stricture. Five had a colorectal anastomotic stricture and 3 had a colorectal anastomotic leak. Complete resolution of the anastomotic stricture or leak was achieved in all patients. Three had recurrence of the anastomotic stricture on 3-month flexible sigmoidoscopy follow-up after the initial stent was removed. Two of these patients had a stricture that was technically too difficult to place another stent. Stent migration was noted in 2 patients, one at day 3 and the other at day 14 after stent placement that required a larger 23 mm stent to be placed. Conclusions. The use of SEMS in the management of colorectal anastomotic leaks or strictures is feasible and is associated with high technical and clinical success rate.

scholarly journals Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

2020 ◽  
Vol 24 (12) ◽  
pp. 1271-1276
Author(s):  
R.-H. Chan ◽  
S.-C. Lin ◽  
P.-C. Chen ◽  
W.-T. Lin ◽  
C.-H. Wu ◽  
...  
Keyword(s):  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Long Term Results ◽  
Endoscopic Dilation ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Aggressive Management ◽  
Anastomotic Strictures

Abstract Background Postoperative colorectal anastomotic strictures are quite common. As such, many techniques have been available to address such a problem, one of which is endoscopic dilation. The aim of the present study was to evaluate the long-term outcomes following endoscopic dilation using a multidiameter balloon. Methods A retrospective study was conducted on patients with postoperative anastomotic stenosis treated with endoscopic dilation using a multidiameter balloon at our institution, in January 2005–December 2019 were retrospectively reviewed, excluding those with tumor recurrence. Perioperative factors, complications, and recurrence rates were analyzed. Results There were 40 patients, (22 males and 18 females, mean age 64.6 ± 10.7 years, range 33–84 years). The median follow-up period was 56 months (interquartile range 22.5–99 months). Only 1 complication occurred, micro-perforation due to guided wire injury, which was managed conservatively. Five (12.5%) patients developed restenosis and underwent repeat balloon dilation. None of the five recurrences required more aggressive management, such as redo anastomosis. Conclusions Endoscopic multidiameter balloon dilation is a safe and effective method for treating benign colorectal anastomotic strictures.

scholarly journals Ureteroenteric strictures: a single center experience comparing Bricker versus Wallace ureteroileal anastomosis in patients after urinary diversion for bladder cancer

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Frank Christoph ◽  
Franziska Herrmann ◽  
Peter Werthemann ◽  
Thomas Janik ◽  
Martin Schostak ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Ileal Conduit ◽  
Anastomotic Stricture ◽  
The Body ◽  
Stricture Formation ◽  
Obese Patients ◽  
Single Institution ◽  
Single Center Experience ◽  
Stricture Rate

Abstract Background To evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis. Methods A total of 137 patients underwent ileal conduit for bladder cancer. Ureters were anastomosed by two experienced surgeons, one performing a Bricker and the other, a Wallace anastomosis. Stricture was identified during clinical follow-up. Results Seventy-five patients underwent a Bricker anastomotic, and 65 received a Wallace anastomosis. The average age was 70 in both groups, males were predominant (66% Bricker, 70% Wallace). Follow up period was 36.5 months in Bricker group and 17 months in Wallace group. In both groups, the body mass index (BMI) was similar (26.1 kg/m2 Bricker and 26.4 kg/m2 Wallace). We observed that the stricture rate after performing the Bricker anastomosis technique was 25.3% (19/75) as compared to 7.7% (5/65) after Wallace anastomosis technique, which was statistically significant (p = 0.001). In the Bricker group, patients with strictures had higher BMI (28.3 vs. 25.7 kg/m2, p = 0.05). On average it took 8.5 months in the Bricker group and three months in the Wallace group (p = 0.6) to develop stricture. Conclusions The stricture rate was significantly higher when Bricker technique was applied. Although the BMI was not different in both groups, patients with a higher BMI were more likely to develop stricture. We believe that the approach of the separate and refluxing technique of Bricker anastomosis especially in obese patients poses a higher risk for anastomotic stricture formation.

Hepaticojejunostomy for Benign Disease: Long-Term Stricture Rate and Management

2019 ◽  
Vol 85 (12) ◽  
pp. 1350-1353 ◽  
Author(s):  
Shannon M. Zielsdorf ◽  
John J. Klein ◽  
Vidya A. Fleetwood ◽  
Martin Hertl ◽  
Edie Y. Chan
Keyword(s):  
Success Rate ◽  
Benign Disease ◽  
Success Rates ◽  
Transplant Patients ◽  
Stricture Rate ◽  
Anastomotic Strictures ◽  
The Mean ◽  
Radiological Intervention

The objective of the study was to determine the long-term stricture rate of hepaticojejunostiomy (HJ) performed for benign disease, to compare stricture rates for transplant patients and non-transplant patients, and to compare the success rates of procedural and surgical treatment options. Hospital charts of 135 consecutive patients undergoing HJ between 1998 and 2016 were analyzed retrospectively. The primary outcome was stricture formation. Secondary outcomes were time to stricture diagnosis and success rates of various interventions. The anastomotic stricture rate was 13.3 per cent (18). The mean follow-up period was 4.3 years. The mean time to stricture diagnosis was 2.3 years. Stricture rates were similar between the transplant (19.2%) and nontransplant, non-Whipple group (13%). Strictures were treated with radiological intervention with a 44.4 per cent success rate; each required multiple interventions. Mortality from liver disease after failure of nonoperative management of HJ strictures reached 30 per cent (3). Five of ten patients who failed radiological intervention underwent HJ revision; the success rate was 80 per cent. Anastomotic strictures of HJ performed for benign disease occur in 13 per cent of patients and typically develop within 2.5 years postoperatively. Yet, given the dangerous sequelae of chronic biliary obstruction and potential delay in presentation, a follow-up is recommended for up to 10 years. When strictures occur, HJ revision should be considered early, after two failed radiological interventions.

scholarly journals Radial incision and cutting combined with balloon dilation for refractory pancreaticojejunostomy anastomotic strictures

2021 ◽  
Vol 09 (04) ◽  
pp. E578-E582
Author(s):  
Tadahisa Inoue ◽  
Mayu Ibusuki ◽  
Rena Kitano ◽  
Yuji Kobayashi ◽  
Tomohiko Ohashi ◽  
...  
Keyword(s):  
Clinical Success ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Recurrence Rates ◽  
Pancreatic Stone ◽  
Radial Incision ◽  
Anastomotic Strictures ◽  
The Mean ◽  
Stricture Recurrence

Abstract Background and study aims Endoscopic balloon dilation (BD) and temporary stent placement for pancreaticojejunostomy anastomotic stricture (PJAS) achieves good short-term outcomes; however, stricture recurrences remain frequent. We examined the feasibility of performing radial incision and cutting (RIC) combined with BD for refractory PJAS. Patients and methods Five consecutive patients with refractory PJAS who underwent RIC with BD between 2015 and 2018 were retrospectively investigated. We evaluated the technical and clinical success, adverse event (AE), and recurrence rates associated with RIC with BD. Results In all five patients, technical and clinical success were achieved. Pancreatic stone removal was simultaneously performed in one patient. The mean procedure time was 18 minutes (range 12–23 minutes). There were no procedure-related AEs. All patients were followed for over 2 years, with a mean follow-up period of 33 months (range 24–40 months). During the follow-up period, none of the patients developed stricture recurrence and all anastomoses remained patent. Conclusions This is the first report of RIC with BD for the treatment of refractory PJAS, showing favorable results. This combined procedure might be a useful option for treating refractory PJAS.

Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study

2018 ◽  
Vol 104 (2) ◽  
pp. 152-157 ◽  
Author(s):  
Floor W T Vergouwe ◽  
John Vlot ◽  
Hanneke IJsselstijn ◽  
Manon C W Spaander ◽  
Joost van Rosmalen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicentre Study ◽  
Anastomotic Leakage ◽  
Oesophageal Atresia ◽  
Anastomotic Stricture ◽  
Multivariable Logistic Regression Analysis ◽  
Exclusion Criteria ◽  
Anastomotic Strictures ◽  
End To End

ObjectiveTo determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures.MethodsRetrospective national multicentre study in patients with OA born between 1999 and 2013. Exclusion criteria were isolated fistula, inability to obtain oesophageal continuity, death prior to discharge and follow-up <6 months. A refractory oesophageal stricture was defined as an anastomotic stricture requiring ≥5 dilations at maximally 4-week intervals. Risk factors for development of refractory anastomotic strictures after OA repair were identified with multivariable logistic regression analysis.ResultsWe included 454 children (61% male, 7% isolated OA (Gross type A)). End-to-end anastomosis was performed in 436 (96%) children. Anastomotic leakage occurred in 13%. Fifty-eight per cent of children with an end-to-end anastomosis developed an anastomotic stricture, requiring a median of 3 (range 1–34) dilations. Refractory strictures were found in 32/436 (7%) children and required a median of 10 (range 5–34) dilations. Isolated OA (OR 5.7; p=0.012), anastomotic leakage (OR 5.0; p=0.001) and the need for oesophageal dilation ≤28 days after anastomosis (OR 15.9; p<0.001) were risk factors for development of a refractory stricture.ConclusionsThe incidence of refractory strictures of the end-to-end anastomosis in children treated for OA was 7%. Risk factors were isolated OA, anastomotic leakage and the need for oesophageal dilation less than 1 month after OA repair.

393 What Are the Risk Factors for Anastomotic Stricture After Bile Duct Injury Repair? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Hall ◽  
J Halle-Smith ◽  
J Hodson ◽  
K Roberts
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Anastomotic Stricture ◽  
Meta Analysis ◽  
Bile Leak ◽  
Legal Cases ◽  
Stricture Rate ◽  
High Level

Abstract Introduction Hepaticojejunostomy (HJ) is the standard repair following major bile duct injury (BDI), but anastomotic stricture can result in long-term morbidity. There is a need to assimilate high-level evidence to establish risk factors for the development of anastomotic stricture after HJ for BDI. Method A systematic review of studies reporting the rate of anastomotic stricture after HJ for BDI was performed according to PRISMA guidelines. Meta-analyses of proposed risk factors were then performed. Results Meta-analysis included five factors (n = 2,198 patients, 17 studies). Vascular injury (OR 2.71; 95%CI 1.37-5.35; p = 0.004), postoperative bile leak (OR: 8.03; 95%CI 2.04-31.71; p = 0.003), previous repair (OR: 5.36; 95%CI 1.04-27.76;p=0.05) and repair by non-specialist surgeon (OR 11.29; 95%CI 5.21-24.47; p &lt; 0.0001) were associated with HJ stricture after BDI. Strasberg injury grade was not associated with HJ stricture (OR: 1.05; 95%CI 0.63-1.75; p = 0.86). Due to heterogeneity of reporting it was not possible to perform meta-analysis for impact of timing of repair on anastomotic stricture rate. Conclusions This meta-analysis identifies factors that significantly increase the rate of anastomotic stricture after HJ for BDI. Knowledge of these risk factors will allow risk stratification in terms of follow-up for individual cases, better informed consent, and guidance for medico-legal cases.

scholarly journals The Circular Stapled Esophagogastric Anastomosis in Esophagectomy: No Differences in Anastomotic Insufficiency and Stricture Rates Between the 25 mm and 28 mm Circular Stapler

2021 ◽  
Author(s):  
E. Tagkalos ◽  
P. C. van der Sluis ◽  
E. Uzun ◽  
F. Berlth ◽  
J. Staubitz ◽  
...  
Keyword(s):  
Anastomotic Stricture ◽  
Circular Stapler ◽  
Median Number ◽  
Stapled Anastomosis ◽  
Esophagogastric Anastomosis ◽  
Ivor Lewis ◽  
Anastomotic Insufficiency ◽  
Ivor Lewis Esophagectomy ◽  
Stricture Rate ◽  
Anastomotic Strictures

Abstract Background For patients undergoing an Ivor Lewis esophagectomy with a circular stapled anastomosis, the optimal diameter of the used circular stapler to restore continuity is unknown. The aim of this study was to compare the 25 mm stapled versus the 28 mm stapled esophagogastric anastomosis after Ivor Lewis esophagectomy, focusing on anastomotic insufficiency and postoperative anastomotic strictures. Methods Between February 2008 and June 2019, 349 consecutive patients underwent Ivor Lewis esophagectomy with gastric conduit reconstruction and circular stapled anastomosis. Patient characteristics and postoperative results, such as anastomotic insufficiency rates, postoperative anastomotic stricture rates, time to anastomotic stricture rate, and the number of dilatations, were recorded in a prospective database and analyzed. Results In 222 patients (64%), the 25 mm circular stapler was used and in 127 patients (36%) the 28 mm circular stapler was used. There were no differences in baseline characteristics. Anastomotic insufficiency rates were comparable between the 25 mm (12%) and the 28 mm groups (11%) (p = 0.751). There were no differences between postoperative anastomotic strictures in the 25 mm (14%) and the 28 mm groups (14%) (p = 0.863). Within patients with postoperative anastomotic strictures, a median number of 2 dilatations were observed in each group (p = 0.573) without differences in the time to first diagnosis (p = 0.412). Conclusion There were no differences in anastomotic insufficiency and postoperative anastomotic stricture rates between the 25 mm and the 28 mm circular stapled esophagogastric anastomosis after Ivor Lewis esophagectomy. Both the 25 mm and 28 mm stapler can be safely used to create a circular stapled esophagogastric anastomosis to restore continuity after esophagectomy.

scholarly journals P-BN46 Risk Factors for Anastomotic Stricture after Hepaticojejunostomy for Bile Duct Injury – A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
James Halle-Smith ◽  
Lewis Hall ◽  
Darius Mirza ◽  
Keith Roberts
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Anastomotic Stricture ◽  
Meta Analysis ◽  
Bile Leak ◽  
Stricture Rate ◽  
Meta Analyses

Abstract Background After major bile duct injury (BDI), hepaticojejunostomy (HJ) is usually required. This can lead to good long-term patency but anastomotic stricture unfortunately remains common cause of long-term morbidity after major BDI. Although risk factors for adverse outcomes of BDI repair are reasonably well understood, there is a need to assimilate high level evidence to establish risk factors specifically for development of anastomotic stricture after HJ for BDI. Methods This was a systematic review of studies reporting rate of anastomotic stricture after HJ for BDI was performed according to PRISMA guidelines. Where possible, meta-analyses were then performed to establish risk factors for anastomotic stricture after HJ for BDI. Results The meta-analyses performed included five factors with a total of 2,155 patients from 17 studies. An increased rate of anastomotic stricture after HJ for BDI was shown amongst patients with concomitant vascular injury (OR 4.96; 95%CI 1.92-12.86; p = 0.001), post-repair bile leak (OR: 8.03; 95%CI 2.04-31.71; p = 0.003) and repair by non-specialist surgeon (OR 11.29; 95%CI 5.21-24.47; p &lt; 0.0001). Level of injury according to Strasberg Grade did not significantly affect the rate of anastomotic stricture (OR: 0.97; 95%CI 0.45-2.10; p = 0.93). Due to heterogeneity of reporting it was not possible to perform meta-analysis for impact of timing of repair on anastomotic stricture rate. Conclusions Repair by a non-specialist surgeon was the only modifiable risk factor revealed by this meta-analysis and systematic review, which demonstrates the importance of broad awareness of these data. That said, knowledge of these risk factors permits evidence-based risk stratification of follow-up as well as better informed consent and understanding of prognosis for patients who have experienced major BDI and require HJ.

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