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At least 73 records · Page 4Linked to original sources
PubMed1976

Long term transhepatic intubation for hilar hepatic duct strictures.

A technique for repairing benign hilar hepatic duct strictures using transhepatic intubation with a large bore silastic stent is described. This procedure has been used in 10 patients. In 9 instances the stricture involved the common hepatic duct, and in one patient the right and left hepatic ducts. Nine of the strictures followed cholecystectomy; one followed the primary repair of a gun shot wound to the hepatic duct. Hepaticojejunostomies were created and the transhepatic silastic stent was left in place for 6 months in one patient, and for 12 months in 8 patients. In one patient the silastic stents are still in place. There have been no treatment failures. All patients are healthy and at full activity from one year, 3 months to 6 years, 6 months from the time of repair (average 3 years, 5 months). In the 9 patients whose stents have been removed, the serum bilirubin levels are normal There have been no episodes of cholangitis following repair. This method of repair using long term transhepatic silastic stents is recommended for all high hilar hepatic duct strictures.

Adult↗
PubMed1984

Hepaticojejunostomy in benign and malignant high bile duct stricture: approaches to the left hepatic ducts.

Biliary-enteric anastomosis for relief of biliary obstruction caused by benign or malignant disease at the confluence of the bile ducts can be difficult. An approach by dissection at the confluence has to be performed directly into an area of scarring or at the site of a neoplastic lesion; exposure of an adequate duct for anastomosis is often difficult and may appear impossible. This paper describes an alternative approach to the hepatic ducts by dissection of the left hepatic ductal system. The method has been used with success in thirty-six patients.

Bile Duct Neoplasms↗
PubMed1993

Long-term survivors after salvage surgery combined with radiotherapy for recurrence of stage IV main hepatic duct cancer--report of two cases.

Main hepatic duct cancer is notorious for its poor prognosis and frequent locoregional failure of therapy even after curative resection. In this paper, two cases of recurrent carcinoma of the stage IVA main hepatic duct are presented. One patient had local failure 13 years after curative resection of the tumor and the other had regional failure 18 months after combination treatment with non-curative resection and intra-operative radiation therapy. Recurrent tumors were successfully treated with combined resection and postoperative radiation therapy or with combined intra-operative radiation therapy and postoperative radiation therapy. The patients are well 16.9 and 6.3 years, respectively, after primary tumor resection. We briefly review a number of other reports of salvage treatment in patients with recurrent carcinoma of the main hepatic ducts and discuss the results with particular reference to the advantage of salvage therapy for the main hepatic duct cancer.

Adenocarcinoma↗
PubMed2001

Right hepatic duct emptying into the cystic duct: report of a case.

BACKGROUND: Anomalous insertion of the right hepatic duct into the cystic duct is a rare anatomic variation. At this writing, only nine cases have been reported in the literature. In the patients presenting with this anomaly, the surgeon may accidentally transect the right hepatic duct during cholecystectomy. METHODS: We encountered a case of anomalous insertion of the right hepatic duct into the cystic duct, which was clearly demonstrated in the intraoperative cholangiography during laparoscopic cholecystectomy. RESULTS: As the half-cut point of the cystic duct happened to be on the gallbladder side of the cystic duct, cholecystectomy was accomplished laparoscopically. CONCLUSIONS: In anomalous insertion of the right hepatic duct into the cystic duct, hepatic duct transection could happen. Preoperative precise evaluation of the biliary duct, awareness of potential biliary variations, and identification of all anatomic structures before ligation and division were essential to prevent bile duct injury.

Aged↗
PubMed1992

[Bronchobiliary fistula in carcinoma of the hepatic duct bifurcation].

Carcinoma of the hepatic duct bifurcation was diagnosed in a 67-year-old women with obstructive jaundice. As metastatic spread could not be demonstrated the carcinoma was removed with a view of achieving a cure (hemihepatectomy, resection of the hepatic duct and the bifurcation, cholecystectomy and hepatojejunostomy). Histological examination indicated adenocarcinoma of the biliary tract. Seven months postoperatively the patient was found to be cachectic and cough up greenish liquid sputum. Bilirubin concentration in sputum was 500 mumol/l. There was no jaundice and total bilirubin concentration was 33 mumol/l. Alkaline phosphatase was 508 U/l, but GOT and GPT were normal (23 U/l and 21 U/l). Computed tomography confirmed the clinical diagnosis of a biliobronchial fistula. The patient died 9 days after renewed hospitalization of tumour cachexia. The biliobronchial fistula was found at necropsy.

Adenocarcinoma↗
PubMed1987

The long-term survival of patients with carcinoma of the main hepatic duct junction.

Carcinoma of the main hepatic duct junction tends to invade extensively the bile ducts and hepatic parenchyma, although dissemination is rarely seen. Therefore, extensive resection of the bile ducts combined with hepatic resection is the procedure of choice for treating this disease. From January 1973 to January 1987, 23 of 41 patients underwent resection, giving a resectability rate of 56%. One patient died postoperatively, yielding an operative mortality rate of 4.3%. The 5-year actuarial survival rate is 29.8%. Three patients are now alive and well 6 years and 9 months, 5 years and 10 months, and 5 years and 5 months after the operation. One additional patient who underwent resection in an affiliated hospital has done well for 8 years and 8 months. The results from these four patients treated by curative resection support a strategy featuring curative resection with aggressive surgery.

Aged↗
PubMed2001

Looping technique for transpapillary selective biopsy of the left hepatic duct.

PURPOSE: Because biopsy forceps tend to turn towards the right hepatic duct during endoscopic retrograde cholangiopancreatography (ERCP), selective access to the left hepatic duct is difficult. METHODS: In this study, we managed to insert biopsy forceps selectively into the left hepatic duct, by using a looping technique, in three patients. Biopsy forceps were inserted into the right hepatic duct by the conventional method. The elevator of the endoscope was kept down, and the shaft of the biopsy forceps was then advanced to the duodenal cavity until it formed a loop between the endoscope and the papilla. During the procedure, the tip of the forceps was kept at the hepatic hilus. RESULTS: In this condition, we were able to slowly rotate the tip of the forceps and direct the forceps towards the left. Sufficient material from the left hepatic duct was obtained in all patients. CONCLUSIONS: The looping technique was useful for selective access to the left hepatic duct.

Adult↗
PubMed1991

[Characteristics of surgical treatment of benign bifurcation strictures of the hepatic ducts].

Experience in the treatment of 195 patients with benign bifurcation stricture of the hepatic ducts is discussed. This group was made up of patients with the cicatricial process involving the region of the bifurcation or continuing to one or both lobar hepatic ducts. Two basic methods of bile--diverting operations were used: with carcass drainage (mono- and bilateral) of the anastomosis and hepatic ducts (n-155) and without a carcass drainage with the formation of a widecholecysto- intestinal anastomosis (through inclusion of the left lobar hepatic duct) by means of interrupted sutures without grasping the mucous membranes of the hepatic ducts and intestine (h-36). A combined method was used in 4 patients with an isolated stenosis of the right hepatic duct and an intact left hepatic duct. Intubation of both lobar hepatic ducts is considered necessary in patients with a bifurcation stricture in the existence of indications for carcass drainage of the bile-diverting anastomosis. Analysis of the immediate and late--term results showed that the postoperative period was more favourable in patients with bilateral carcass drainage of the bile-diverting anastomosis and in those with a precision anastomosis that in patients with monolateral drainage (complications occurred, respectively, in 16.3% and 46.6% of patients, and a good late-term results was encountered, respectively, in 78.5% and 55% of patients). The stricture did not recur in patients with a precision anastomosis and in those with bilateral carcass drainage.

Anastomosis, Surgical↗
PubMed1984

Paraganglioma of the common hepatic duct.

A case of paraganglioma arising in the common hepatic duct is reported. The patient presented with obstructive jaundice. At operation, a soft mass, 5 X 2 X 1.8 cm, was found firmly adherent to the intraluminal surface of the common hepatic duct. At cholecystectomy, exploration of the common hepatic duct was performed and the mass was partially removed. T-tube choledochostomy and operative cholangiography were performed. The final pathological report was paraganglioma of the common hepatic duct. The patient was clinically improved on discharge.

Bile Duct Neoplasms↗
PubMed1997

Ductoplasty for an aberrant hepatic duct in a choledochal cyst.

The confluence of the right and left hepatic ducts at the hepatic hilum frequently shows normal anatomic variations. Choledochal cysts (CC) are also accompanied by similar variations, and devices for free drainage of bile are occasionally required in biliary reconstruction. We present a CC that had an aberrant posterior branch of the right hepatic duct draining into the distal common hepatic duct. A capacious hepaticoduodenostomy at the hilum was performed after joining the hilar and aberrant ducts.

Child, Preschool↗
PubMed1994

Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: a cooperative study of the Keio Bile Duct Cancer Study Group.

BACKGROUND: It is necessary to elucidate whether extensive resection of the bile ducts combined with liver resection is a feasible and valid procedure for cancer of the main hepatic duct junction. METHODS: Based on a multi-institutional study, resectability rate, operative mortality, long-term survival, and factors contributory to long-term survival were investigated. RESULTS: Between January 1973 and December 1991, a total of 158 patients with this cancer were admitted to Keio University Hospital and six affiliated institutions. Eighty-three (53%) of the 158 patients underwent resection, with seven (8.4%) postoperative deaths. The operations were performed by seven surgeons who were in charge of liver surgery at each respective institution. The 5-year actuarial survival rate of the 83 patients who underwent resection was 20%. Twelve patients survived more than 5 years, and these patients underwent curative resection. Three of the 12 patients were doing well after 10 years. Procedures of liver resection were right trisegmentectomy in two patients and left lobectomy with resection of the right portal vein in one. CONCLUSIONS: It is clear that cancer of the main hepatic duct junction has become a curable disease. The operation is a valid procedure that can be widely practiced by competent surgeons.

Adenocarcinoma↗
PubMed1991

Postresection autopsy findings in patients with cancer of the main hepatic duct junction.

Extensive resection of the bile ducts combined with hepatic resection is the procedure of choice for carcinoma of the main hepatic duct junction. Currently this procedure is done without great risk, and increasing long-term survival is now the issue. For this purpose, it is necessary to elucidate the biologic properties of the cancer to take reasonable measures. Autopsy findings of patients who died of recurrence may offer a reliable guide. Autopsy findings were studied in 14 patients: eight who had undergone curative resection and six who had received noncurative resection. Cancer recurred at the liver hilum with invasion into adjacent organs. Peritoneal dissemination and lymph node metastases were infrequent. These were common findings in both curative and noncurative resection groups. Cancer cells in the connective tissue of the hepatoduodenal ligament may play a major role in recurrence.

Adenocarcinoma↗
PubMed1981

Surgical management of spontaneous hepatic duct perforations.

Spontaneous rupture of the hepatic ducts is an exceedingly rare and unusually unrecognized cause of peritonitis in adults. In the last four years we have operated on three patients with bile peritonitis from hepatic duct perforation caused by calculus erosion. All were elderly, had a prolonged period of symptoms prior to presentation, and were gravely ill at the time of operation. Each perforation was managed differently: one by fine suture closure, one by insertion of a T-tube in the perforation, and the third by T-tube drainage of the common duct when the perforation was inaccessible to repair. Two of the three patients survived and remain healthy without evidence of bile duct stricture three and three and a half years later, respectively.

Aged↗