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Biliary Duct Injury
Partial Segment IV Resection for Intrahepatic Reconstruction of Biliary Lesions
Miguel Angel Mercado, MD;
Héctor Orozco, MD;
Lorenzo de la Garza, MD;
Luz María López-Martínez, MD;
Alan Contreras, MD;
Erika Guillén-Navarro, MD
Arch Surg. 1999;134:1008-1010.
A technique for intrahepatic reconstruction of the biliary tree after complex high injuries is described. The fundament of the procedure is the removal of a wedge of segment IV at the level of the hilar plate. When the hilar plate is reached and no adequate exposure of the ducts can be obtained, removing a 1x1-in wedge of segment IV between the gallbladder bed and the round ligament exposes the left and right ducts. An anteroposterior view of the plate is obtained instead of a caudocephalic dissection, exposing healthy, nonscarred ducts for reconstruction. We have used this approach in 22 patients, and adequate exposure of the ducts has been obtained, with a high success rate of patency of the anastomosis at a mean follow-up of 3 years. Twenty patients have a patent anastomosis, with a good quality of life and no restenosis.
From the Department of Surgery, National Institute of Nutrition, Salvador Zubirán, Tlalpan, Mexico.
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