The new DEAL - a novel technique using a double-entry access loop to facilitate bilateral intrahepatic biliary access for complex intrahepatic stones
Journal Article
2006
Permanent link to this Item
Authors
Journal Title
South African Journal of Surgery
Link to Journal
Journal ISSN
Volume Title
Publisher
Health and Medical Publishing Group
Publisher
University of Cape Town
Department
Faculty
License
Series
Abstract
The management of patients with primary intrahepatic stones may be complex as the natural history is frequently complicated by further episodes of cholangitis after initial treatment because of residual or recurrent intrahepatic stones or strictures.1 Curative segmental or lobar hepatic resection of atrophic segments and diseased ducts is possible in only the 20% of patients with localised stones or strictures.2 Complete stone removal by resection is therefore not feasible in the majority of patients with bilateral lobar stones and strictures. Patients who subsequently develop cholangitis pose a major operative risk if secondary biliary cirrhosis, portal hypertension or the atrophy-hypertrophy complex has occurred.3 Treatment of recurrent stones and strictures via the percutaneous transhepatic biliary route is successful in only 70% of patients.3 In order to avoid these hazards, to reduce the incidence of incomplete operative stone removal and to facilitate extraction of recurrent intrahepatic stones, we have used a multidisciplinary approach in complex hepatolithiasis, combining resection of atrophic liver segments with a modified hepaticojejunostomy incorporating permanent access for interventional radiological procedures via a jejunal access loop.
Description
Reference:
Kriger, J. E. J., & Beningfield, S. J. (2006). The new DEAL-a novel technique using a double-entry access loop to facilitate bilateral intrahepatic biliary access for complex intrahepatic stones. South African Journal of Surgery, 44(2), 56-58.