Hepaticojejunostomy without suture.

Abstract

Common bile duct (CBD) surgery sometimes demands performing 'a la Roux' hepaticojejunal anastomosis. This kind of stoma is technically easy to perform on a biliary stump of sufficient width (> 8 mm), sufficient length (> 0.5 cm) and with a resilient wall so that stitches will not cut off. In some cases, however, the anatomical conditions are poor: short or thin biliary stump. This situation is especially encountered in iatrogenic lesions of the main biliary channel, but it can infrequently be found in some malignant lesions of the CBD. The authors present their procedure of hepaticojejunal anastomosis without suture, which is adequate for the treatment of benign or even malignant stenosis of the CBD. The method realizes anastomosis of the segments without using sutures by simply keeping them in apposition with continuous traction exerted via a Foley-type balloon catheter which stents the anastomosis in an axial manner. The balloon is then inflated and traction is exerted on the catheter, enabling the two segments of the anastomosis to remain in place until complete healing (10 days average). We performed the procedure in 7 cases: 4 for neoplastic stenosis, and 3 for an accidental lesion of the CBD. There was no perioperative morbidity and 1 fatal outcome. The results prompt further evaluation of the method.