The relationship between a subcutaneously placed afferent jejunal loop in a hepaticojejunostomy and postoperative cholangitis.
A subcutaneously placed afferent jejunl loop pexis, which is often performed during a hepaticojejunostomy, opens a route to the biliary tract, through which appropriate instruments can be passed should postoperative complications arise, requiring a choledochoscopy, the removal of calculi, and for the dilatation of the anastomotic site. From our clinical experience with such a pexis, however, postoperative cholangitis showing a transient fever with abdominal pain and liver dysfunction frequently develops. Further, in cases in which a subsequent dissection of this jejunal pexis was performed, there was a reduction in the incidence of cholangitis, which suggests a possible correlationship between such a pexis and cholangitis. In this investigation, bile stasis in jejunal loop has been studied, using hepatobiliary scintiscanning in examining 31 patients given a hepaticojejunostomy. Fourteen of these patients were also given a jejunal loop pexis, and 17 patients were without such a pexis. Bile stasis was found to be more frequent in the group given a jejunal loop pexis (p less than 0.001). Further, bile stasis was found in 90% of patients showing postoperative cholangitis whereas postoperative cholangitis was observed in 60% of patients with bile stasis (p less than 0.01). Thus, based on the data obtained, as well as our clinical experience, it would seem that a subcutaneously placed jejunal loop pexis should be avoided while performing a hepaticojejunostomy, unless the possibility of anastomotic stenosis and/or the retention of stones are strongly expected.
Takada
T
T
First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Yasuda
H
H
Uchiyama
K
K
Hasegawa
H
H
Shikata
J
J
Kuniyasu
Y
Y
D000713:Anastomosis, Roux-en-Y; D002761:Cholangitis / Q000209:etiology*; D002768:Choledochostomy; D002779:Cholestasis / Q000209:etiology*; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007081:Ileostomy; D007583:Jejunum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*