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Frey procedure for the treatment of chronic pancreatitis associated with common bile duct stricture

Hepatobiliary & Pancreatic Diseases International 2013年第6期12卷 637-644页

作者： Lionel Rebibo thierry yzet Cyril Cosse Richard Delcenserie Eric Bartoli Jean-Marc Regimbeau Department of Digestive Surgery Amiens University Medical Center the Jules Verne University of Picardie Department of Radiology Amiens University Medical Center and the Jules Verne University of Picardie Department of Digestive SurgeryAmiens University Medical Center and the Jules Verne University of Picardie Department of Gastroenterology Amiens University Medical Center and the Jules Verne University of Picardie

BACKGROUND:The Frey procedure(FP)is the treatment of choice for symptomatic chronic pancreatitis(CP).In cases of biliary stricture,biliary derivation can be performed by choledochoduodenostomy,Roux-en-Y choledochojejunostomy or,more recently,reinsertion of the common bile duct(CBD)into the resection *** objective of the present study was to evaluate the outcomes associated with each of these three types of biliary ***:We retrospectively analyzed demographic,CPrelated,surgical and follow-up data for patients having undergone FP for CP with biliary derivation between 2004and 2012 in our university medical *** primary efficacy endpoint was the rate of CBD stricture *** secondary endpoints were surgical parameters,postoperative complications,postoperative follow-up and the presence of risk factors for secondary CBD ***:Eighty patients underwent surgery for CP during the study *** these,15 patients received biliary derivation with the *** of the FPs(53.3%)were combined with choledochoduodenostomy,4(26.7%)with choledochojejunostomy and 3(20.0%)with reinsertion of the CBD into the resection *** mean operating time was *** complications(73.3%)were recorded,including one major complication(6.7%)that necessitated radiologicallyguided drainage of an abdominal *** mean(range)length of stay was 17 days(8-28)and the median(range)follow-up time was 35.2 months(7.2-95.4).Two patients presented stricture after CBD reinsertion into the resection cavity;one was treated with radiologically-guided dilatation and the other underwent revisional Roux-en-Y *** patients presented alkaline reflux gastritis(37.5%),one(12.5%)cholangitis and one CBD stricture after FP with *** risk factors for secondary CBD stricture were ***:As part of a biliary derivation,the FP gave good *** did not observe any complications specifically relat

关键词： common bile duct stricture chronic pancreatitis Frey procedure pancreatectomy

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Multidisciplinary management of Mirizzi syndrome with cholecystobiliary fistula: the value of minimally invasive endoscopic surgery

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Hepatobiliary & Pancreatic Diseases International 2015年第5期14卷 543-547页

作者： Fabien Le Roux Charles Sabbagh Brice Robert thierry yzet Laurent Dugue Jean-Paul Joly Jean-Marc Regimbeau Department of Digestive and Oncological Surgery Amiens University Hospital Jules Verne University of Picardie Department of Interventional and Diagnostic Imaging Amiens University Hospital Jules Verne University of Picardie Department of Digestive Surgery Saint-Camille Hospital Department of Hepatogastroenterology Amiens University Hospital Jules Verne University of Picardie

Mirizzi syndrome, a rare complication of gallstones, is defined by obstruction of the main bile duct. This obstruction may worsen and thus result in cholecystobiliary fistula. Surgical management of Mirizzi syndrome is complicated by the presence of inflamed tissue around the hepatic pedicle, making it impossible to distinguish between the main bile duct and the gallbladder. The surgeon＇s first task is to perform subtotal cholecystotomy（from the fundus of the gallbladder to the neck） without trying to locate the cystic duct. In a second step, the gallstones are extracted and the main bile duct is then repaired. In most cases, a T-tube is used to drain the main bile duct, and abdominal drainage is left in place（in case a bile fistula forms）. This study concluded that preoperative drainage of the main bile duct in the treatment of Mirizzi syndrome types II and III is feasible and might help to decrease the postoperative complication rate.

关键词： jaundice Mirizzi syndrome cholecystobiliary fistula endoscopic treatment cholecystectomy T-tube drain

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Combined radiologic and endoscopic treatment(using the “rendezvous technique”) of a biliary fistula following left hepatectomy

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World Journal of Gastroenterology 2016年第30期22卷 6955-6959页

作者： Aurélien Gracient Lionel Rebibo Richard Delcenserie thierry yzet Jean-Marc Regimbeau Service de Chirurgie Digestive H?pital Sud CHU d'Amiens Avenue René LaennecF-80054 Amiens cedex 01 France Department of Gastroenterology Amiens University Hospital Avenue René Laennec F-80054 Amiens cedex 01 France Department of Radiology Amiens University Hospital Avenue René Laennec F-80054 Amiens cedex 01 France EA4294 Jules Verne University of Picardie F-80054 Amiens cedex 01 France Clinical Research Center Amiens University Hospital Avenue René Laennec F-80054 Amiens cedex 01 France

Despite the ongoing decrease in the frequency of complications after hepatectomy, biliary fistulas still occur and are associated with high morbidity and mortality rates. Here, we report on an unusual technique for managing biliary fistula following left hepatectomy in a patient in whom the right posterior segmental duct joined the left hepatic duct. The biliary fistula was treated with a combined radiologic and endoscopic procedure based on the "rendezvous technique". The clinical outcome was good, and reoperation was not required.

关键词： Left hepatectomy Rendezvous technique biliary stent biliary fistula Anatomic variation

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