Start your free 3-day trial — no credit card required, full access included

DE EN ES
Login Register

Complications - Standard bilioenteric anastomosis

general and visceral surgery
Activate now
Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative complications

    • Bile duct injury > suture, possibly bile duct drainage
    • Injury to the hepatic artery and its branches >end-to-end anastomosis, possibly patch angioplasty
    • Intestinal injury > suture

  2. Postoperative complications

    • Postoperative bleeding > usually within the first 24 hours > immediate revision surgery first identifying the cause and then definitely controlling the bleeding.
    • Cholangitis > antibiotic regimen
    • Biliary obstruction (fever, icterus, pain) > normal for the first few days due to postoperative edema; in case of persistent obstruction ERCP or PTC with stenting; re-anastomosis after 6-8 weeks the earliest.
    • Pancreatitis > nonsurgical management
    • Delayed gastric emptying/ileus > often indirect signs of peritonitis > CT; Beware of aspiration!
    • Failure of the bilioenteric anastomosis >

    * Patient stable without signs of peritonitis > leave target drain in place, check drainage volume, work-up with CT study, possibly MRCP

    In suspected peritonitis > revision surgery with placement of an enterohepatic drain and suture; re-anastomosis rarely indicated.

    • Failure of the jejunal anastomosis >

    * Jejunal secretions draining through the wound; suspect drainage fluid, i.e., either clearly jejunal contents or secretions with bilirubin/amylase levels elevated compared with serum; oral administration of toluidine blue and its appearance in the target drain.

    * Drains already removed: Ultrasound- or CT-guided centesis, possibly with drainage

    * Upper GI series and CT-study with water soluble contrast agent cannot rule out leakage of the jejunal anastomosis!

    * Enterocutaneous fistulas, originating in particular from the blind end of the jejunum, can be managed without revision surgery.

    * Deciding factor here is the clinical situation of the patient: Pain with signs of local and general peritonitis or sepsis with elevated levels of infection parameters in lab studies > even if work-up is inconclusive, do not delay revision surgery!

    • Intermittent cholangitis with late sequela of stenosis > stenting, possibly re-anastomosis