ATRAUMATIC METHOD OF INTRAOPERATIVE RETROGRADE TRANSHEPATIC BILIARY STENT INSERTION

A significant risk of hepatic injury remains using reported methods of intraoperative retrograde transhepatic stenting (IRTS). Our hypothesi s was that we could minimize this risk by: (1) using a pliable sheath to create a stent tract that follows the curve of the biliary tree, (2 ) decreasing the stent diameter, and (3) avoiding the hepatic hilum. W e evaluated the safety of a novel technique of intraoperative stenting employing these three concepts. Twenty-four patients underwent IRTS b etween 1992 and 1995 at our institution after potentially curative res ection (one bypass). Malignant disease was present in 22 of 24 patient s. Bile ducts were normal caliber in all patients. There was no operat ive mortality and 38% operative morbidity, all readily treated. All co mplications were due to stent dislodgment. There were no deaths. This novel atraumatic method of IRTS has acceptable morbidity and mortality . Complications due to stent insertion are minimal. The technique comp ares favorably with previous methods of IRTS and offers a viable alter native to the surgeon when a transhepatic stent is required. Anchoring the stent securely to the skin is essential to prevent catheter dislo dgement. (C) 1996 Wiley-Liss, Inc.