Hepatobiliary scintigraphy after biliary reconstruction--a comparative study on Roux-Y and ESCD

Reconstruction of extrahepatic biliary tract with benign lesion still has some unsettled problems, such as postoperative cholangitis. This study was conducted to compare bile through the remnant alimentary tract in patients undergoing end-to-side choledochoduodenostomy, and those undergoing Roux-Y choledochojejunostomy, using hepatobiliary scintigraphy.

Five normal human volunteers and 13 patients underwent end-to-side choledochoduodenostomy (n = 5), Roux-Y choledochojejunostomy (n = 8), using hepatobiliary scintigraphy.

Postoperative acute cholangitis developed in 1 patient (12%) with Roux-Y choledochojejunostomy and none with end-to-side choledochoduodenostomy. Hepatobiliary scintigraphy showed prominent stasis of 99mTc in the proximal jejunum loop of the patients who underwent the Roux-Y choledochojejunostomy procedure, which was not found in the upper jejunum of the patients with end-to-side choledochoduodenostomy. The time taken before visualization of 99mTC at the upper jejunum in the patient who underwent Roux-Y choledochojejunostomy (66.5 +/- 5 min) was significantly longer than that in the healthy controls (40 +/- 5 min). On the other hand, the time taken before visualization of 99mTc at the upper jejunum in end-to-side choledochoduodenostomy (35 +/- 5 min) was similar to that of healthy controls.

This data suggested that end-to-side choledochoduodenostomy procedure for reconstructing the extrahepatic biliary tract was more physiological with less postoperative complication than Roux-Y choledochojejunostomy procedure.