Jejunal mucosal graft: a sutureless technic for repair of high bile duct strictures

A simplified sutureless technic for the repair of high bile duct strictures is described. The technic combines the principle of a transhepatic tube together with a mucosal graft formed by removing a seromuscular patch near the end of a Roux-en-Y loop of jejunum creating a mucosal outpouching. The biliary tree is entered at the hilum of the liver and a latex rubber tube is drawn through the liver and anchored to the Roux-en-Y loop through the previously created mucosal diverticulum. The tube is pulled back into the liver carrying with it the sleeve of jejunal mucosa into the duct system in contact with the epithelium of the intrahepatic ducts. The technic is simple, easy, and quick. There is no difficult and tedious duct dissection of hepaticodochojejunal anastomosis to perform. It provides mucosa to mucosa approximation and eliminates the need for sutures through or near the mucosa to compromise the blood supply and prevent primary healing. The stent tube is easily removed without reoperation when desired. Finally, there is access to the biliary tree for daily irrigation, radiography, and cultures. From 1969 to 1972, sixty-one repairs were performed in fifty seriously ill patients utilizing the principles of this sutureless technic. All had had failure of previous attempts at repair with an average of 2.86 previous biliary tract operations per patient. Eight-five per cent of the patients have had an ultimately successful result. The mean postoperative hospital stay was only 19.6 days. Although the follow-up period is still short, these preliminary results are most encouraging.