Bile Duct Replacement in Hepatobiliary Surgery: A Systematic Review.

Background: Roux-en-Y hepaticojejunostomy (RYHJ) is currently the standard surgical technique for reestablishing biliary continuity, but it exposes the patient to serious biliary complications, such as anastomosis stricture and ascending cholangitis.

Methods: The literature on biliary replacement using vein grafts as autologous substitutes according to the different stages of the IDEAL framework was reviewed.

Results: Innovative biliary replacement techniques using bile duct substitutes have yet to reach stage 2a (development) of the IDEAL framework. Vein grafts are the most frequently used substitutes in animals and human studies. Twenty-three patients have undergone bile duct reconstruction using four different substitutes: vein grafts (n = 13), omentum/round ligament (n = 5), jejunum (n = 4), and Teflon (n = 1). Biliary replacement using an autologous vein graft (n = 13) was performed for bile duct injury following cholecystectomy (n = 12) or hepatectomy (n = 1). The 90-day mortality rate was zero. Morbidity occurred within 90 days in two patients (15.4%). Twelve patients were alive at the last follow-up.

Conclusions: Autologous venous graft as a substitute for biliary replacement may be an appealing alternative to RYHJ in hepatobiliary surgery, but this technique is still being developed.