An essential technique for modern hepato-pancreato-biliary surgery: minimally invasive biliary reconstruction

ABSTRACT

Introduction: Minimally invasive reconstruction of the biliary tract is complex and involves multiple steps. The procedure is challenging and has been an essential technique in modern hepato-pancreato-biliary surgery in recent years. Additionally, the quality of the reconstruction directly affects long-and short-term complications and affects the prognosis and quality of life. Various minimally invasive reconstruction methods have been developed to improve the reconstruction effect; however, the optimal method remains controversial.

Areas covered: In this study, were viewed published studies of minimally invasive biliary reconstruction within the last 5 years and discussed the current status and main complications of minimally invasive biliary reconstruction. More importantly, we introduced the current reconstruction strategies and technical details of minimally invasive biliary reconstruction, which may be potentially helpful for surgeons to choose reconstruction methods and improve reconstruction quality.

Expert opinion: Although several improved and modified methods for biliary reconstruction have been developed recently, no single approach is optimal or adaptable to all situations. Patient-specific selection of appropriate technical strategies according to different situations combined with sophisticated and skilled minimally invasive techniques effectively improves the quality of anastomosis and reduces complications.

KEYWORDS:

• Biliary reconstruction
• hepaticojejunostomy
• laparoscopic technology
• minimally invasive
• robotic surgery

Article highlights

• The biliary reconstruction under minimally invasive is mainly classified as hepaticojejunostomy and hepatoduodenostomy. Hepaticojejunostomy has become the most popular method of biliary reconstruction, which is suitable for the vast majority of cases. However, in special cases, hepatoduodenostomy also has its unique advantages.

• Biliary reconstruction under minimally invasive is still being explored, and the comparison between laparoscopy and robotic, and between single-port and multi-port approaches is still under debate.

• A variety of factors, including technical and patient factors, influence the short - and long-term complications of biliary reconstruction.

• Details of biliary reconstruction technique performed under minimally invasive, such as suture materials, cholangioplastysuture method, use of transanastomoticstents, port location and use of 3D technique, may affect the quality of reconstruction.

• Personalized methods of biliary reconstruction under minimally invasive may more effectively reduce morbidity.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the health project of Jilin province department of Finance (2019SCZT009,2018GDYYZ001 and 2018FP030).