Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1978 Oct;188(4):552–561. doi: 10.1097/00000658-197810000-00012

The use of silastic transhepatic stents in benign and malignant biliary strictures.

J L Cameron, B W Gayler, G D Zuidema
PMCID: PMC1396841  PMID: 697437

Abstract

Between 1969 and 1978, 45 patients with biliary strictures have been managed surgically utilizing silastic transhepatic stents. In 25 patients the strictures were benign. After resection or dilatation of the benign stricture, an hepaticojejunostomy was performed to a Roux-en-Y loop. The anastomosis was stented with a large bore silastic tube with multiple side holes passed through the biliary tree, out the anterior surface of the liver, and then out through the abdominal wall. There was one hospital death. Most stents were left in place for one year. Of the 15 patients with long-term follow-up, all have had excellent results. In 20 patients the strictures were malignant and involved the common hepatic duct in 10 patients or its bifuraction in 10 patients. In 14 patients the tumor was thought to be primary in the biliary tree, and in six patients the tumor was felt to represent a metastasis or direct extension from another site. In three patients the tumors were resected, and in the remaining they were dilated or bypassed. After positioning a silastic transhepatic stent, a hepaticojejunostomy was carried out. There were two hospital deaths. Serum bilirubin on admission average 17.1 mg%, and after decompression 1.8 mg%. Five patients have survived over one year, and two over two years. Postoperative radiotherapy and a primary biliary tumor favored longer survival.

Full text

PDF
558

Images in this article

554Fig. 1.
on p.554
555Fig. 2.
on p.555
556Fig. 4.
on p.556

Selected References

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

  1. 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]
  2. Cameron J. L., Skinner D. B., Zuidema G. D. Long term transhepatic intubation for hilar hepatic duct strictures. Ann Surg. 1976 May;183(5):488–495. doi: 10.1097/00000658-197605000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. KLATSKIN G. ADENOCARCINOMA OF THE HEPATIC DUCT AT ITS BIFURCATION WITHIN THE PORTA HEPATIS. AN UNUSUAL TUMOR WITH DISTINCTIVE CLINICAL AND PATHOLOGICAL FEATURES. Am J Med. 1965 Feb;38:241–256. doi: 10.1016/0002-9343(65)90178-6. [DOI] [PubMed] [Google Scholar]
  4. 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]
  5. Longmire W. P., McArthur M. S., Bastounis E. A., Hiatt J. Carcinoma of the extrahepatic biliary tract. Ann Surg. 1973 Sep;178(3):333–345. doi: 10.1097/00000658-197309000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Praderi R. C. Twelve years' experience with transhepatic intubation. Ann Surg. 1974 Jun;179(6):937–940. doi: 10.1097/00000658-197406000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. SMITH R. HEPATICOJEJUNOSTOMY WITH TRANSHEPATIC INTUBATION: A TECHNIQUE FOR VERY HIGH STRICTURES OF THE HEPATIC DUCTS. Br J Surg. 1964 Mar;51:186–194. doi: 10.1002/bjs.1800510307. [DOI] [PubMed] [Google Scholar]
  8. Saypol G. M., Kurian G. A technique of repair of stricture of the bile duct. Surg Gynecol Obstet. 1969 May;128(5):1071–1076. [PubMed] [Google Scholar]
  9. Starzl T. E., Porter K. A., Putnam C. W., Schroter G. P., Halgrimson C. G., Weil R., 3rd, Hoelscher M., Reid H. A. Orthotopic liver transplantation in ninety-three patients. Surg Gynecol Obstet. 1976 Apr;142(4):487–505. [PMC free article] [PubMed] [Google Scholar]
  10. Terblanche J., Saunders S. J., Louw J. H. Prolonged palliation in carcinoma of the man hepatic duct junction. Surgery. 1972 May;71(5):720–731. [PubMed] [Google Scholar]
  11. Warren K. W., Mountain J. C., Midell A. I. Management of strictures of the biliary tract. Surg Clin North Am. 1971 Jun;51(3):711–731. doi: 10.1016/s0039-6109(16)39447-6. [DOI] [PubMed] [Google Scholar]
  12. Way L. W., Dunphy J. E. Biliary stricture. Am J Surg. 1972 Aug;124(2):287–295. doi: 10.1016/0002-9610(72)90026-8. [DOI] [PubMed] [Google Scholar]
  13. 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]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES