A New Surgical Technique of Biliary Drainage

Shafiqul Hoque

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

DOI: 10.4236/ijcm.2013.49072                

Abstract

Introduction: Roux-en-Y Hepatico-jejunostomy is the standard technique of biliary reconstruction after excision of choledochal cyst. Here the author describes a new surgical technique of biliary reconstruction using native gall bladder as biliary conduit. New Surgical Technique: The choledochal cyst is excised as standard technique but gall bladder with its neck is kept in situ. The gall bladder neck is anastomosed with the common hepatic duct stump and gall bladder fundus is anastomosed with the antero-inferior wall of the first part of distal duodenum. Materials & Methods: Eleven patients with choledochal cyst have been operated with the new technique from July 2011 to December 2012 in the city of Dhaka, Bangladesh. Feeding was started from 3rd post-operative day and drain was removed by 7th day unless complicated and they were released from the hospital between 10-15 days. Results: The ages of eleven patients were from 3 months to 11 years. There were 7 females and 4 males. Lump was felt in 3 patients and jaundice was present in 4 patients. Recurrent abdominal pain was present in all patients. They were diagnosed by ultrasonography and MRCP was done in 6 patients only. Prothrombin time was elevated by 10% & 15% in 2 patients. Average operation time was 2 hours and 10 minutes. A 9-year girl died suddenly and unexpectedly on the 5th post-operative day from severe convulsion of unknown origin. One child suffered from prolonged bile leakage and re-explored to repair anastomotic leak. Another patient had a collection near the anastomosis which resolved spontaneously. Discussion: Benefits of the new surgical technique are total absence of Roux-en-Y related intestinal complications. Possible disadvantages are discussed. It is anatomical and physiological. Small incision and less operation time are other benefits which need to be mentioned. Possible disadvantages are discussed.

Keywords

Biliary Reconstruction; Bilioenteric Anastomosis; Choledocho-Cholecystostomy; Cholecysto-Duodenostomy; Choledocho-Cholecysto-Duodenostomy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Z. Li, N. Cui and L. Chen, “Treatment Experience of Subsequent Complications after Roux-en-Y Biliojejunostomy,” European Surgical Research, Vol. 43, No. 1, 2009, pp. 34-38. doi:10.1159/000216521
[2]	E. Elhalaby, A. Hashish, M. Elbarbary and M. Elwagih, “Roux-en-Y Hepaticojejunostomy versus Hepaticoduodenostomy for Biliary Reconstruction after Excision of Choledochal Cysts in Children,” Annals of Pediatric Surgery, Vol. 1, No. 1, 2005, pp. 79-85
[3]	P. Stefanini, M. Carboni, N. Patrassi, A. Basoli, G. de Bernardinis and P. Negro, “Roux-en-Y Hepaticojejunostomy: A Reappraisal of Its Indications and Results,” Annals of Surgery, Vol. 181, No. 2, 1975, pp. 213-219. doi:10.1097/00000658-197502000-00016
[4]	G. Pappalardo, S. Correnti, S. Mobarhan, P. Trentino, A. Pietropaolo, F. Frattaroli and G. Castrini, “Long-Term Results of Roux-en-Y Hepaticojejunostomy and Hepaticojejunoduodenostomy,” Annals of Surgery, Vol. 196, No. 2, 1982, pp. 149-152. doi:10.1097/00000658-198208000-00006
[5]	A. Shimotakahara, A. Yamataka, T. Yanai, H. Kobayashi, T. Okazaki, G. J. Lane and T. Miyano, “Roux-en-Y Hepa tico-Jejunostomy for Biliary Reconstruction during the Surgical Treatment of Choledochal Cyst: Which Is Better?” Pediatric Surgery International, Vol. 21, No. 1, 2005, pp. 5-7. doi:10.1007/s00383-004-1252-1
[6]	G. Halff, S. Todo, R. Hall and T. E. Starzl, “Late Complications with Gall Bladder Conduit Biliary Reconstruction after Liver Transplantation,” Transplantation, Vol. 48, No. 3, 1989, pp. 537-539. doi:10.1097/00007890-198909000-00044
[7]	K. Congo, M. F. Lopes, P. H. Oliveira, H. Matos, S. Basso and A. Reis, “Outcomes of Choledochal Cysts with or without Intrahepatic Involvement in Children after Extrahepatic Cyst Excision and Roux-en-Y Hepaticojejunostomy,” Annals of Hepatology, Vol. 11, No. 4, 2012, pp. 536-543.
[8]	M. T. Santore, B. J. Behar, T. A. Blinman, E. J. Doolin, H. L. Hedrick, P. Mattei, M. L. Nance, N. S. Adzick and A. W. Flake, “Hepaticoduodenostmy versus Hepaticojejunostomy for Reconstruction after Resection of Choledochal Cyst,” Journal of Pediatric Surgery, Vol. 46, No. 1, 2011, pp. 209-213. doi:10.1016/j.jpedsurg.2010.09.092
[9]	S. Hirano, E. Tanaka, T. Tsuchikawa, J. Matsumoto, T. Shichinohe and K. Kato, “Technique of Biliary Reconstruction Following Bile Duct Resection,” Journal of Hepatobiliary-Pancreatic Sciences, Vol. 19, No. 3, 2012, pp. 203-209. doi:10.1007/s00534-011-0475-5
[10]	N. Akamatsu, Y. Sugawara and D. Hashimoto, “Biliary Reconstruction, Its Complications and Management of Biliary Complications after Adult Liver Transplantation: A Systematic Review of the Incidence, Risk Factors and Outcome,” Transplant International, Vol. 24, No. 4, 2011, pp. 379-392. doi:10.1111/j.1432-2277.2010.01202.x
[11]	F. Cianci, F. Al Oraifi, F. Tareen and M. Corbally, “Choledochal Cyst: Our Ten Year Experience,” Irish Medical Journal, Vol. 105, No. 4, 2012, pp. 110-113.
[12]	S. S. Saluja, M. Nayeem, B. C. Sharma, G. Bora and P. K. Mishra, “Management of Choledochal Cysts and Their Complications,” American Surgeons, Vol. 78, No. 3, 2012, pp. 284-290.
[13]	A. J. Oishi, M. G. Sarr, D. M. Nagomey, M. D. Traynor and P. Mucha Jr., “Long-Term Outcome of Cholecystoenterostomy as a Definitive Biliary Drainage Procedure for Benign Disease,” World Journal of Surgery, Vol. 19, No. 4, 1995, pp. 616-619. doi:10.1007/BF00294736
[14]	D. P Vogt and R. E Hermann, “Choledochoduodenostomy, Choledochojejunostomy or Sphincteroplasty for Biliary and Pancreatic Disease,” Annals of Surgery, Vol. 190, No. 2, 1981, pp. 161-168.
[15]	R. M. Walsh, J. M. Henderson, D. P. Vogt and N. Brown, “Long-Term Outcome of Biliary Reconstruction for Bile Duct Injuries from Laparoscopic Cholecystectomies,” Surgery, Vol. 142, No. 4, 2007, pp. 450-456. doi:10.1016/j.surg.2007.07.008
[16]	R. F. Saidi, N. Ilias, D. Sc Ko, T. Kawai, J. Markmann, A. B. Cosimi and M. Hartl, “Biliary Reconstruction and Complications after Living-Donor Liver Transplantation,” HPB (Oxford), Vol. 11, No. 6, 2009, pp. 505-509. doi:10.1111/j.1477-2574.2009.00093.x
[17]	B. Mukhopadhyay, R. M. Shukla, M. Mukhopadhyay, K. C. Mandal, P. P. Mukharjee, D. Roy, S. K. Biswas and K. S. Basu, “Choledochal Cyst: A Review of 79 Cases and the Role of Hepaticodochoduodenostomy,” Journal of Indian Association of Pediatric Surgeons, Vol. 16, No. 2, 2011, pp. 54-57. doi:10.4103/0971-9261.78131