Medical Library - Medical Teaching Hospital, Maribor (SBMB)
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Surgical anatomy of the segmental bile duct (B3) of the liver : surgical importance of the round ligament approach
Karamarković, R. Aleksandar ...
Under some circumstances (deep hilum, tumor involving of the main hepatic ducts) adequate biliary drainage can only be obtained by holangio-enteric anastomosis to the intrahepatic branches. Round ...ligament approach to the segmental bile duct (B3) is useful for palliation of hilar cholangiocarcinoma and unresectable gallbladder cancer. Decompression of the 30% of liver substance is enough to restore hepatic function in jaundiced patients. There was no difference in the quality of palliation or in the mean survival rate regardless of the presence or absence of hilar communication between the right and left ductal system. The confluence pattern and surgical anatomy of the bile duct branch of segment 3 of the liver (B3) was studied in 61 specimens (28 adult cadavers and 33 liver casts). It is important to understand the detailed anatomy of B3, its confluence patterns and its relation to the segmental portal venous branch P3. We did not register any anatomical variations of segmental biliary ducts B2 and B3. Since March 2001, we have performed intrahepatic segmental bile duct 3 (B3) cholangiojejunostomy by Roux-en-Y fashion utilizing a round ligament approach in six patients with malignant obstructive jaundice to unresectable hilar cholangiocarcinoma (4 cases) and gallbaldder cancer (2 cases). Transanastomic stent was used in four cases.The postoperative surgical complications (postoperative bleeding, bile leakage, abcess formation) and hospital mortality were not registered. The palliation of symptoms was effective in postoperative period. During the follow-up period from 2-12 months, there was one lethal outcome (16%). The segment 3 intrahepatic (B3) cholangiojejunostomy is a safe and effective procedure in the palliative treatment of unresectable high biliary malignant lesions. Also, round ligament approach, with intrahepatic cholangio-enteric by-pass provides enough distance from a malignant lesion.
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