Viszeralchirurgie 2004; 39 - 19
DOI: 10.1055/s-2004-835095

The „inspection jejunostomy“ after complex reconstructions of the central bile ducts – Indications, description of the procedure and personal experience

C Knorr 1, S Kastl 2, T Horbach 1, W Hohenberger 1
  • 1Chirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg
  • 2Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie der Universität Hamburg-Eppendorf

Introduction:

A modified Roux-en-Y hepaticojejunostomy with the afferent limb brought up as jejunostomy has been described in 1984 by Hutson and Russell (4). It facilitates endoscopic retrograde access to the biliary tree for control examinations and biopsies in complicated reconstructive procedures after bile duct resection. We report our experience with this operative procedure.

Methods:

After having performed complicated bile duct resection, the reconstruction was performed as a modified Roux-en-Y hepaticojejunostomy with the 20cm afferent limb brought up as terminal jejunostomy in the right upper abdominal quadrant. Postoperative follow-up comprised endoscopic and radiologic controls of the biliary tree every 3 months for one year; ileostomy resection was performed one year later if the postoperative course was undisturbed.

Results:

From 03/1995 to 02/2002 we performed this operation in 17 patients (mean age 56yrs.). Indications were previous lesions of the common bile duct after laparoscopic (n=7) or open cholecystectomy (n=4), common bile duct resections in cholangiocellular carcinoma and gallbladder carcinoma with unclear intraoperative safety margins (n=3), malignant granulosa cell tumour and simultaneous cholangiocellular carcinoma, focal nodal hyperplasia, Mirizzi-syndrome and one patient with intrahepatic recurrent stone formation after orthotopic liver transplantation.

The endoscopic and radiologic (cholangiography) diagnostic procedures – performed every 3 months postoperatively – were uneventful.

Conclusions:

The modified Roux-en-Y hepaticojejunostomy with the afferent limb brought up as jejunostomy permits good control and intervention possibilities in complicated bile duct surgery after bile duct lesions, tumor resection with unclear resectional margins and in recurrent intrahepatic stone formation.

Keywords: biliodigestive anastomosis, jejunostomy, biliary complications, bile duct stenosis