Hilar cholangioplasty using omentum for ductal defect in biliobiliary fistula

Background/purpose A non-circumferential defect of the biliary system is occasionally faced at surgery for biliobiliary fistula. The condition represents an uncommon but important complication of gallstone disease. Although direct closure and patch repair using the gallbladder cuff are recommended as first-line treatments, these procedures are sometimes technically difficult in the presence of severe inflammation. The authors, herein, present a novel procedure denoted as hilar cholangioplasty, which utilizes the pedicled omentum. Methods An 80-year-old man was referred to our hospital because of cholangitis. Endoscopic retrograde cholangiography demonstrated a large gallstone astride the common hepatic duct with upstream biliary dilation, indicating biliobiliary fistula. Upon laparotomy, a 2 × 3 cm ductal defect was found just under the hepatic bifurcation, after removal of the gallstones and the gallbladder. The surrounding tissue, as well as the bile duct, was extensively inflamed with dense fibrosis, such that first-line repair methods could not be performed. As an alternative method, the pedicled omentum was used for cholangioplasty. Results Postoperative cholangioscopy showed a yellow polypoid mass without constriction. Histologically, ordinary biliary epithelium overlaid the surface of the grafted omentum. The patient has remained well at 3-year follow-up. Conclusion The present method is simple and could be a promising option when standard repair methods cannot be applied.