Search

Interventional procedure via percutaneous transhepatic route is often performed, as an initial treatment, in patients with benign bilioenteric anastomotic stricture. However, surgical management is required in most cases in which radiological intervention is unsuccessful. In this report, we describe a case of a 67-year-old woman with recurrent bilioenteric anastomotic stricture, accompanying bilateral hepatolitiasis after several times of transhepatic interventions. The patient underwent intrahepatic cholangiojejunostomy (Longmire procedure) and cholangioscopic lithotomy after resection of an atrophic left lateral segment resulting from hepatolithiasis. Although the damaged hilar bile duct had to be isolated and divided from the corresponding vasculature for re-anastomosis, it was quite impossible due to severe inflammatory change at the hepatic hilus. We, therefore, anastomosed the intact biliary stump on the cut surface of the left lateral segment to the jejunal loop with a stent tube. The patient's postoperative course was uneventful and she exhibited no evidence of cholangitis during follow-up period of 1 year after surgery. At present, the indications for intrahepatic cholangiojejunostomy for biliary obstruction, are quite limited, but biliary surgeons should keep this procedure in mind at the time of biliary reconstruction for benign proximal bile duct stricture, particularly in cases of multiply operated hilum.

Background/aims: Patients with both hepatocellular carcinoma and hypersplenic thrombocytopenia are occasionally seen and this condition can severely complicate liver resection. This study evaluated the usefulness of preoperative partial splenic embolization (PSE) as an alternative to splenectomy (SP)., Methodology: Twenty-eight patients with hypersplenic thrombocytopenia underwent hepatectomy for hepatocellular carcinoma. Five patients underwent preoperative PSE and 23 patients underwent concomitant splenectomy. The blood cell counts, laboratory chemistry data, and operative morbidity, prognosis were all examined., Results: There were no severe PSE-related complications such as splenic abscess seen after PSE. The platelet counts in the PSE group significantly increased in comparison to those in the SP group before the operation. The frequency of blood transfusion and postoperative complications in the PSE group was significantly less than that in the SP group. The duration of surgery, blood loss, and performance of PSE were significant factors to predict postoperative complications. The overall survival after liver resection was not significantly different between patients in the PSE and SP group., Conclusions: Preoperative PSE could be safely performed without severe adverse effects prior to liver resection and it was thus considered to be useful for increasing the number of platelets and reducing postoperative complications.

The occluded biliary expandable metallic stent (EMS) placed for postoperative stricture of bilioentero-anastomosis can be treated with percutaneous interventional procedures, but most EMSs eventually re-occlude after a certain period of time with sludge/stone or epithelial hyperplasia. The complete removal of EMS is, therefore required for a good long-term outcome. Surgical procedures with EMS removal, and re-bilioenteric anastomosis after resection of damaged bile ducts, are usually complex and difficult, especially when the proximal end of the EMS is located at the second or more proximal biliary branch. In such cases, we have devised a new technique for complete EMS removal and more proximal hepatic duct resection by separating the liver parenchyma along the interlobar plane (anterior transhepatic hepatic approach). Liver transection is performed along the left side of the middle hepatic vein until good exposure of the hilar plate is obtained. The EMS is then extracted, together with resection of the dense/damaged intrahepatic ducts for re-biliary reconstruction. The anterior transhepatic approach may be a very useful procedure for approach to the second or more proximal biliary ducts without hepatic resection.

Background/aims: Management of patients with recurrent intrahepatic cholangiocarcinoma (ICC) following surgical resection is difficult, and surgical resection is rarely indicated. We retrospectively reviewed patients with recurrent intrahepatic cholangiocarcinoma., Methodology: Between April 1998 and March 2007, 57 consecutive patients with ICC underwent surgical resection. Mode of recurrence and treatment of recurrent tumors, especially surgical resection for these tumors, in patients with cancer recurrence were evaluated., Results: 37 (65%) patients experienced tumor recurrence. Out of these patients, 24 underwent some type of cancer-directed therapy, including 9 patients (24%) for whom surgical resection was attempted: the latter included 4 hepatic resections, 2 pulmonary resections, 2 tumor resections, and 1 gastric resection. For 6 patients with recurrent tumor in the liver or the lung, microscopic complete resection was achieved, while incomplete resection was resulted in the remaining 3 patients. No postoperative mortality was encountered. Among patients with complete resection, 3 are alive without disease 32, 39 and 77 months after the second operation, one has lived with disease for 13 months, and 2 died of disease after 22 and 26 months. No significant difference in overall survival was observed between patients undergoing primary and second surgical resections, calculated from the primary and the second operations, respectively., Conclusions: Repeated surgical resection for recurrent ICC can be performed with acceptable morbidity, and affords selected patients a chance for long-term survival.

We report our experience of surgical treatment for a patient with pancreatic injury, who presented with pancreatic ascites 2 months after a blunt abdominal trauma. A 20-year-old woman was admitted to our hospital due to massive ascites and dehydration. This patient was diagnosed as having pancreatic ascites caused by the rupture of pancreatic pseudocyst, and the pseudocyst seemed to have caused by the trauma that she sustained 2 months before. As non-surgical treatment did not bring about an improvement of the patient status, she underwent cystogastrostomy. Postoperative course was uneventful and the patient was discharged on the 25th postoperative day. The patient is doing well 7 years after surgery without any signs of pancreatic pseudocyst or diabetes. A case of pancreatic ascites presenting after a significant time period following initial abdominal trauma has not been reported.