Cholangio-duodenal interposition of an isolated jejunal segment after central resection.
BACKGROUND
Bilio-intestinal drainage is routinely performed by Roux-en-Y reconstruction after resection of the central bile duct. Alternatively reconstruction can be achieved by cholangio-duodenal interposition of an isolated jejunal segment (CDJI). This method offers the benefit of potential endoscopic control and intervention during follow-up. Critics of CDJI assume a higher rate of postoperative cholangitis compared to the Roux-en-Y construction.


METHODS
Seventy-six patients with malignant tumors (n=56) or benign strictures and choledochal cysts (n=20) were treated between 1989 and 2002 by cholangio-duodenal interposition of an isolated jejunal segment (measuring 15-25 cm) after central bile duct resection. In 22 patients endoscopic control was first performed postoperatively during hospitalization. In 12 patients bilio-intestinal anastomosis could be inspected endoscopically. In the remaining patients the anastomosis could not be visualized endoscopically because of kinking of the jejunal segment, but in all patients it could be evaluated by endoscopic retrograde cholangiography (ERC).


RESULTS
During follow-up, 25 (33%) patients died from extrahepatic tumor recurrence. Three patients receiving CDJI after severe iatrogenic bile duct injury developed anastomotic strictures. Two of these patients were treated by endoscopic pigtail drainage, and one was treated by percutaneous drainage. Two patients who had received CDJI after choledochal cyst resection developed cholestasis postoperatively because of sludge formation (1 patient) and an intrahepatic concrement (1), which could be solved endoscopically. One patient after resection of a Klatskin tumor developed an anastomotic stricture which could not be visualized endoscopically, making percutaneous drainage necessary. The rate of postoperative cholangitis after CDJI in our patients was comparable to that after the Roux-en-Y reconstruction.


CONCLUSIONS
Interposition of an isolated jejunal segment for reconstruction after bile duct resection should be performed in patients with a high risk of postoperative stenosis. To benefit endoscopic follow-up the jejunal segment should be shorter than 20 cm
Moellmann
Barbara
B
Department of General & Thoracic Surgery, University Hospital Kiel, Arnold Heller Strabetae 7, 24 105 Kiel, Germany.
Ruhnke
Mareu
M
Kremer
Bernd
B
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000601:surgery; D001660:Biliary Tract Diseases / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002768:Choledochostomy / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008875:Middle Aged; D016896:Treatment Outcome