ARCHIVES OF THE BALKAN MEDICAL UNION

Axial stenting of the hepaticojejunal anastomoses

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Background: The aim of a biliary-digestive derivation is, in fact, restoring biliary transit no matter the obstacle. There are three essential factors that make this possible: the biliary partner of the anastomosis, the digestive partner and the anastomosis stoma itself. Over the time, many attempts were made, so that nowadays hepaticojejunal anastomosis on isolated loop is imposed. In this way alimentary pollution of the biliary sector is avoided, as well as the reflux cholangitis, a disadvantage that occurs in other types of biliary-digestive anastomoses.

Methods: This is a retrospective, unicentric, multi-operative study, performed on 267 anastomoses, 148 with axial drainage, 119 without drainage, 209 malignant and 58 benign.

Results: Final results show the predominance of stented anastomoses over the non-stented ones. 103 from the 148 stented anastomoses (94%) were made using axial drainage. It was determined that the evolution was favorable for the drained patients in what regards both the fast or relatively slow remission of the icteric syndrome and the decrease in the patients with very slow or incomplete remission, though without observing significant differences. During the study, some complications occurred: hemorrhage complications in one patient, two septic complications, partially or totally malfunctioning drainage and anastomotic fistulas.

Conclusions: Despite the relatively difficult way of the set up and the bigger possibility of accidental mobilization of the tube, axial stenting of the hepaticojejunal anastomosis is the gold standard in derivations due to its best possible results on short and long terms while avoiding alimentary pollution of the biliary segment.

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