Clinical Gastroenterology Vol.17 No.10(5-1)

Theme Recent Issues of Pancreaticobiliary Maljunction
Title Surgical Treatment of Adult Pancreaticobiliary Maljunction
Publish Date 2002/09
Author Hitoshi Hara Department of General and Gastroenterological Surgery, Osaka Medical College / Hara Clinic for Surgery and Gastroenterology
Author Takehiko Dohi Department of General and Gastroenterological Surgery, Osaka Medical College
Author Mitsuhiko Iwamoto Department of General and Gastroenterological Surgery, Osaka Medical College
Author Hitoshi Inoue Department of General and Gastroenterological Surgery, Osaka Medical College
Author Masaru Kawai Department of General and Gastroenterological Surgery, Osaka Medical College
Author Nobuhiko Tanigawa Department of General and Gastroenterological Surgery, Osaka Medical College
[ Summary ] To treat pancreaticobiliary maljunction with dilatation of the common bile duct, extrahepatic bile duct resection is performed and biliary tract reconstruction is generally performed.
The bile duct on the pancreatic side is cut at the confluence site between the common bile duct and pancreatic duct. In respect to the bile duct on the hepatic side, a large anastomotic orifice is made at the hepatic portal outside of the stenotic region in Todani type IV-A patients. A similar procedure is performed at the hepatic bile duct in other patients. For reconstruction of the biliary digestive tract, hepatoduodenostomy, hepatojejunostomy using the Roux-en-Y method, and jejunal interposition in which the pediculate jejunum is implanted between the hepatic duct and the duodenum are performed. The Roux-en-Y method or hepatoduodenostomy is performed for reconstruction of the biliary digestive tract in adults. In particular, jejunal interposition is contraindicated for Todani type IV-A patients. Furthermore, we encountered a Todani type IV-A patient who developed cholangiocarcinoma after hepatoduodenostomy. In patients undergoing hepatoduodenostomy, sufficient follow-ups are needed.
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