Portoenterostomy - An old treatment for a new disease

Hypothesis: Portoenterostomy may be an effective treatment for patients sus taining a thermal injury to the hepatic duct confluence during laparoscopic cholecystectomy. Design: Case series. Setting: A tertiary care referral hospital. Patients: A consecutive series of 5 female patients referred and treated be tween November 13, 1991, and December 17, 1998. Ages ranged from 29 to 65 y ears. In addition to the ductal injuries at or above the hepatic duct confl uence, 3 patients also had a major hepatic vascular injury. The patients we re available for follow-up for 7 to 91 months postoperatively. Interventions: All patients underwent a portoenterostomy (Kasai procedure) with suturing of a Roux limb to the hepatic tissue surrounding, the transec ted hepatic ducts. Transhepatic stents were inserted either preoperatively or postoperatively for rising liver enzyme levels in 4 patients. Main Outcome Measures: Symptoms and results of liver function tests. Results: Stents remained in place for 9 to 25 months in 4 patients. All 5 p atients were symptom free and functioning normally; 3 had normal liver func tions; 2 had mildly elevated alkaline phosphatase levels only. Conclusion: Portoenterostomy, usually in combination with postoperative ste nting, may be an option to consider in life-threatening injuries involving the hepatic duct bifurcation in which standard biliary reconstruction techn iques are not feasible.