title: A subcutaneous or subfascial jejunostomy is beneficial in the surgical management of extrahepatic bile duct cancers.
abstract: BACKGROUND
  Extrahepatic bile duct cancers are rare tumors with a dismal prognosis. Even after a resection, obstructive cholestasis and other biliary complications are the rule. To facilitate retrograde access to the biliary tree for treatment of such biliary complications, a modified Roux-en-Y hepaticojejunostomy is constructed such that the afferent limb is brought up as a subcutaneous or subfascial jejunostomy (SJ). The safety and utility of construction of an SJ was evaluated in patients with extrahepatic cholangiocarcinoma.
  
  
  METHODS
  From 1985 to 1997, 24 patients with extrahepatic bile duct cancers received an SJ as part of their management. Demographic data, operative data, tumor characteristics, and postoperative courses were retrospectively reviewed. All but 3 patients were followed to the time of death.
  
  
  RESULTS
  The average age of the patients was 62 +/- 9 years. The tumor was resected in 17 patients. Major complications occurred in 5 patients (21%). There was 1 operative death (4%). None of the complications could be attributed to construction of the SJ, although 1 patient had a soft tissue infection at the site of the percutaneous access of the SJ. Frequent dilatations of biliary strictures were required in 5 patients, and 1 patient eventually required insertion of an internal biliary stent. These procedures could all be accomplished through the SJ.
  
  
  CONCLUSIONS
  The SJ is a technically simple and safe addition to the management of resectable and unresectable extrahepatic bile duct cancers, particularly proximal lesions. The procedure facilitates brachytherapy if indicated, and it allows convenient management of postoperative biliary complications, including recurrent strictures.
authors.affiliation: Department of Surgery, University of Miami, Fla., USA.
authors.forename: O F
authors.initials: OF
authors.lastname: Bathe
authors.forename: J T
authors.initials: JT
authors.lastname: Pacheco
authors.forename: P B
authors.initials: PB
authors.lastname: Ossi
authors.forename: D
authors.initials: D
authors.lastname: Franceschi
authors.forename: D
authors.initials: D
authors.lastname: Sleeman
authors.forename: D G
authors.initials: DG
authors.lastname: Hutson
authors.forename: E
authors.initials: E
authors.lastname: Russell
authors.forename: J U
authors.initials: JU
authors.lastname: Levi
authors.forename: A S
authors.initials: AS
authors.lastname: Livingstone
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic; D001918:Brachytherapy; D005260:Female; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications