Abstract

SANTILLAN-LOMELI, Ivette et al. Uso de ASA subaponeurótica de acceso biliar para la dilatación endoscópica percutánea de estenosis de hepaticoyeyunoanastomosis. Endoscopia [online]. 2019, vol.31, suppl.2, pp.65-71.  Epub Feb 14, 2022. ISSN 2444-6483.  https://doi.org/10.24875/end.m19000052.

The construction of an hepaticojejunostomy is a surgical method of bypass used for the resolution of pathological conditions of the extrahepatic bile ducts, which allows biliary drainage into the small intestine. (1,2) There are several complications that can occur in this technique, such as bile leak and biliary fistula (early complications); one of the long-term complications, is stenosis, which can lead to multiple hospitalizations and major procedures for its resolution. (3,4) Previously, the great problem of stenosis after biliodigestive bypasses was that several major surgeries were needed to manage it. Therefore, it is increasingly necessary to develope new techniques with less morbidity. (5) This new approach has already been implemented in 82 cases of biliary reconstruction, through an access loop direct to the bile duct, through which endoscopic therapy can be performed. First patient case, 27 years old with Strasberg E4 biliary lesion, hepatoejejunostomy was performed with subaponeurotic loop and formation of neoconfluence, 18 months after surgery, asymptomatic jaundice and bile duct dilatation were detected by cholangioresonance. A successful endoscopic dilation was performed through it. However, at 20 months after the dilation it occurs again. It was necessesary to perform another endoscopic dilation through the subaponeurotic loop, being a succesful treatment after 20 months follow up. Second patient case, a 51 year old patient with Strasberg E3 biliary lesión, we performed hepaticojejunostomy with subaponeurotic loop. During postoperative follow-up, asymptomatic jaundice was documented at 24 months and dilatation of the biliary tract by cholangioresonance was evidenced. An endoscopic dilation was performed through the subaponeurotic loop with success. He has remained under surveillance for 36 months without recurrence. The technique of hepaticojejunostomy with a subaponeurotic loop, allows easy access and minimal invasive procedures to the biliodigestive anastomosis for its rehabilitation in case of stenosis.

Keywords : Dilation; Endoscopy; Stenosis; Hepaticojejunostomy.

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