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. 1985 Nov;202(5):539–545. doi: 10.1097/00000658-198511000-00002

Management of injuries to the porta hepatis.

G F Sheldon, R C Lim, E S Yee, S R Petersen
PMCID: PMC1250965  PMID: 4051602

Abstract

The management of injuries to the porta hepatis is challenging and controversial. Although definitive, anatomic reconstruction of injured ductal or vascular structures is optimal, porta hepatis injuries are universally accompanied by injuries to other organs (3.6 in this series), which often precludes initial repair. Moreover, frequent injury to the inferior vena cava, aorta, or other major blood vessels in addition to the structures of the porta hepatis results in these injuries being treated in conjunction with exsanguinating hemorrhage. For that reason, control of hemorrhage is the initial management priority, with the initial operation requiring expeditious, if less than anatomically exact, operations. Eighteen of 31 patients survived porta hepatis injury. Hepatic artery injuries were treated by ligation. Complex injuries to bile ducts frequently required enteric-ductal anastomoses as secondary procedures. Of 29 patients with portal vein injuries, six were treated by ligation, 22 by lateral repair, and one with splenic vein interposition graft. As in earlier reports, the structure of the porta hepatis associated with the highest morbidity and mortality rates when injured was the portal vein.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bismuth H., Franco D., Corlette M. B., Hepp J. Long term results of Roux-en-Y hepaticojejunostomy. Surg Gynecol Obstet. 1978 Feb;146(2):161–167. [PubMed] [Google Scholar]
  2. Blumgart L. H., Drury J. K., Wood C. B. Hepatic resection for trauma, tumour and biliary obstruction. Br J Surg. 1979 Nov;66(11):762–769. doi: 10.1002/bjs.1800661103. [DOI] [PubMed] [Google Scholar]
  3. Boey J. H., Way L. W. Acute cholangitis. Ann Surg. 1980 Mar;191(3):264–270. doi: 10.1097/00000658-198003000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bolton J. S., Braasch J. W., Rossi R. L. Management of benign biliary stricture. Surg Clin North Am. 1980 Apr;60(2):313–332. doi: 10.1016/s0039-6109(16)42083-9. [DOI] [PubMed] [Google Scholar]
  5. Bordley J., 4th, White T. T. Causes for 340 reoperations on the extrahepatic bile ducts. Ann Surg. 1979 Apr;189(4):442–446. [PMC free article] [PubMed] [Google Scholar]
  6. Braasch J. W., Warren K. W., Blevins P. K. Progress in biliary stricture repair. Am J Surg. 1975 Jan;129(1):34–37. doi: 10.1016/0002-9610(75)90163-4. [DOI] [PubMed] [Google Scholar]
  7. Burt T. B., Nelson J. A. Extrahepatic biliary duct trauma--a spectrum of injuries. West J Med. 1981 Apr;134(4):283–289. [PMC free article] [PubMed] [Google Scholar]
  8. Busuttil R. W., Kitahama A., Cerise E., McFadden M., Lo R., Longmire W. P., Jr Management of blunt and penetrating injuries to the porta hepatis. Ann Surg. 1980 May;191(5):641–648. doi: 10.1097/00000658-198005000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cahow C. E. Intrahepatic cholangiojejunostomy: a new simplified approach. Am J Surg. 1979 Apr;137(4):443–448. doi: 10.1016/0002-9610(79)90112-0. [DOI] [PubMed] [Google Scholar]
  10. Cameron J. L., Gayler B. W., Harrington D. P. Modification of the Longmire procedure. Ann Surg. 1978 Apr;187(4):379–382. doi: 10.1097/00000658-197804000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cameron J. L., Gayler B. W., Zuidema G. D. The use of silastic transhepatic stents in benign and malignant biliary strictures. Ann Surg. 1978 Oct;188(4):552–561. doi: 10.1097/00000658-197810000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Daugherty M., Ernst C. B., Sachatello C. R., Griffen W. O. Proximal hepatic duct reconstruction. Repair using sutureless mucosal graft hepaticojejunostomy. Arch Surg. 1978 Apr;113(4):490–495. doi: 10.1001/archsurg.1978.01370160148025. [DOI] [PubMed] [Google Scholar]
  13. FLETCHER W. S., MAHNKE D. E., DUNPHY J. E. Complete division of the common bile duct due to blunt trauma. Report of a case and review of the literature. J Trauma. 1961 Mar;1:87–95. doi: 10.1097/00005373-196103000-00001. [DOI] [PubMed] [Google Scholar]
  14. Fletcher W. S. Nonpenetrating trauma to the gallbladder and extrahepatic bile ducts. Surg Clin North Am. 1972 Jun;52(3):711–717. doi: 10.1016/s0039-6109(16)39743-2. [DOI] [PubMed] [Google Scholar]
  15. Graham J. M., Mattox K. L., Beall A. C., Jr Portal venous system injuries. J Trauma. 1978 Jun;18(6):419–422. doi: 10.1097/00005373-197806000-00006. [DOI] [PubMed] [Google Scholar]
  16. Haynes C. D., Given K. S., Stone H. H., Smith R. B., 3rd Nonsurgical trauma to the extrahepatic bile ducts. South Med J. 1969 Nov;62(11):1323–1326. doi: 10.1097/00007611-196911000-00004. [DOI] [PubMed] [Google Scholar]
  17. Hertzer N. R., Gray H. W., Hoerr S. O., Hermann R. E. The use of T-tube splints in bile duct repairs. Surg Gynecol Obstet. 1973 Sep;137(3):413–418. [PubMed] [Google Scholar]
  18. JOHNSTONE F. R. Acute ligation of the portal vein. Surgery. 1957 Jun;41(6):958–971. [PubMed] [Google Scholar]
  19. LEE J. G., WHERRY D. C. Traumatic rupture of the extra hepatic biliary ducts from external trauma. J Trauma. 1961 Mar;1:105–114. doi: 10.1097/00005373-196103000-00003. [DOI] [PubMed] [Google Scholar]
  20. LIPPMAN H. N., LONGMIRE W. P., Jr Intrahepatic cholangiojejunostomy; an operation for biliary obstruction. Surg Clin North Am. 1956 Aug;:849–863. [PubMed] [Google Scholar]
  21. Longmire W. P., Jr, Tompkins R. K. Lesions of the segmental and lobar hepatic ducts. Ann Surg. 1975 Oct;182(4):478–495. doi: 10.1097/00000658-197510000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lucas C. E., Ledgerwood A. M. Liver necrosis following hepatic artery transection due to trauma. Arch Surg. 1978 Sep;113(9):1107–1107. doi: 10.1001/archsurg.1978.01370210089014. [DOI] [PubMed] [Google Scholar]
  23. Maier W. P., Lightfoot W. P., Rosemond G. P. Extrahepatic biliary ductal injury in closed trauma. Am J Surg. 1968 Jul;116(1):103–108. doi: 10.1016/0002-9610(68)90427-3. [DOI] [PubMed] [Google Scholar]
  24. McFadden P. M., Tanner G., Kitahama A. Traumatic hepatic duct injury: new approach to surgical management. Am J Surg. 1980 Feb;139(2):268–271. doi: 10.1016/0002-9610(80)90271-8. [DOI] [PubMed] [Google Scholar]
  25. Pachter H. L., Spencer F. C. Recent concepts in the treatment of hepatic trauma: facts and fallacies. Ann Surg. 1979 Oct;190(4):423–429. doi: 10.1097/00000658-197910000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Petersen S. R., Sheldon G. F., Lim R. C., Jr Management of portal vein injuries. J Trauma. 1979 Aug;19(8):616–620. doi: 10.1097/00005373-197908000-00009. [DOI] [PubMed] [Google Scholar]
  27. Rossi R. L., Gordon M., Braasch J. W. Intubation techniques in biliary tract surgery. Surg Clin North Am. 1980 Apr;60(2):297–312. doi: 10.1016/s0039-6109(16)42082-7. [DOI] [PubMed] [Google Scholar]
  28. Skow J. R., Longmire W. P., Jr Common duct stricture secondary to blunt abdominal trauma. Am Surg. 1974 Oct;40(10):576–578. [PubMed] [Google Scholar]
  29. Smale B. F., Ring E. J., Freiman D. B., Oleaga J. A., Reichman R., Mullen J. L., Rosato E. F. Successful long-term percutaneous decompression of the biliary tract. Am J Surg. 1981 Jan;141(1):73–76. doi: 10.1016/0002-9610(81)90015-5. [DOI] [PubMed] [Google Scholar]
  30. Stefanini P., Carboni M., Patrassi N., Basoli A., de Bernardinis G., Negro P. Roux-en-Y hepaticojejunostomy: a reappraisal of its indications and results. Ann Surg. 1975 Feb;181(2):213–219. doi: 10.1097/00000658-197502000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Stone R. M., Cohen Z., Taylor B. R., Langer B., Tovee E. B. Bile duct injury. Results of repair using a changeable stent. Am J Surg. 1973 Feb;125(2):253–256. doi: 10.1016/0002-9610(73)90036-6. [DOI] [PubMed] [Google Scholar]
  32. TYGSTRUP N., WINKLER K., MELLEMGAARD K., ANDREASSEN M. Determination of the hepatic arterial blood flow and oxygen supply in man by clamping the hepatic artery during surgery. J Clin Invest. 1962 Mar;41:447–454. doi: 10.1172/JCI104497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wexler M. J., Smith R. Jejunal mucosal graft: a sutureless technic for repair of high bile duct strictures. Am J Surg. 1975 Feb;129(2):204–211. doi: 10.1016/0002-9610(75)90299-8. [DOI] [PubMed] [Google Scholar]
  34. Zollinger R. M., Jr, Keller R. T., Hubay C. A. Traumatic rupture of the right and left hepatic ducts. J Trauma. 1972 Jul;12(7):563–569. doi: 10.1097/00005373-197207000-00003. [DOI] [PubMed] [Google Scholar]

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