[Hepaticojejunal anastomosis in a regional surgical facility]

A retrospective assessment of the post-surgical and long-term results of the high biliodigestive anastomoses constructed using the authors' own technique modification.

This study evaluates 25 patient cases during an 8-year-period. The patients had high biliodigestive anastomosis affixed due to the clinically manifested obstructive icterus or due to repetitive attacks of cholangitides. The underlying causes of the attacks were malignancies of the ductus hepatocholedochus in 13 cases, a stricture of the ductus hepatocholedochus following the drainage according to Kehr in 1 case, an inflammative stenosis of the ductus hepatocholedochus during choledocholithiasis in 1 case, the Mirizzi syndrome in 2 cases, a cyst of the ductus hepatocholedochus in 2 cases, a stricture of the ductus hepatocholedochus following choledochoduodenoanastomosis in 4 cases, hepaticolithiasis in 1 case, a status after cholecystogastrostomy in 1 case, and a status after ductus hepatocholedochus contusion in 1 case. The immediate post-surgical progress and complications and the long-term survival rate, as well as any signs of the intrahepatic cholestasis, were assessed.

Out of the 13 cases of the hepatochodochus malignancy, in 5 cases it was resected and only in 8 cases a paliative anastomosis was performed. A classical hepaticojejunoanastomosis was performed in 14 cases, anastomosis according to Hepp-Couinaud in three cases, the Smith telescopic anastomosis in 2 cases, the Hutson loop in 4 cases, an anastomosis to the biliary duct in the recess of Rex in 2 cases. In 2 cases a post-surgical biliary fistula, once multiple liver abscesses, in 3 cases exitus due to the malignancy progress during hospitalization and once a suppurative inflammatory process in the wound appeared. Two female patients who underwent resection of the ductus hepatocholedochus due to a malignancy have been surviving for 12 and 66 months. None of the 12 patients who underwent hepaticojejunoanastomoses due to benign strictures had signs of the post-surgical cholestasis. One female patient died after 13 months following the surgery due to the cardial causes.

The paliative hepaticojejunoanastomosis without malignancy resection is followed by a short-term survival rate. Only following the simultaneous ductus hepatocholedochus resection, an exceptional case of a long-term patient survival may be expected, with a questionable curative effect. The hepatojejunoanastomosis construction according to our modification never caused a biliary fistula. The both cases of anastomoses to the biliary duct in the recess of Rex caused a transient biliary fistula. If in doubts about the long-term function of the anastomosis, the Hutson loop application appears to be of advantage.