[Biliodigestive anastomoses; a modality for resolving mechanical jaundice]

Over a period of 14 years a total of 1,996 surgical procedures have been performed on extrahepatic biliary pathways. In 182 cases (9.11%) biliodigestive anastomoses have been done for a therapeutical solution of mechanical jaundice. Biliodigestive anastomoses have been mandatory in 76 cases (41.76%) because of mechanical jaundice induced by biliary stones. In 106 cases the anastomosis was carried out in an attempt to solve mechanical jaundice that was not induced by biliary stones but by other causes. In 45 cases the lesions that had determined the jaundice were benign, and in 61 of the cases malignancy was at the origin of the jaundice. The following types of anastomosis were employed: choledochoduodenal anastomoses were done in 120 cases (65.93%); hepatic duct-duodenal anastomoses in 15 cases (19.23%); hepatojejunal anastomoses in 7 cases (3.84%); recalibration of previous anastomoses in 5 cases (2.74%). These surgical methods, applied in cases of various etiologies, most of them quite severe, in debilitated patients, with iterative surgery, were associated with early postoperative mortality of 8% (13 cases), and a general morbidity of 35% (65 cases), which included: fistulae, anastomotic stenoses, acute postoperative pancreatitis, angiocholitis and suppuration. The late results were good, depending on the etiology of the mechanical jaundice. The authors preferred choledochoduodenal anastomosis for benign lesions, and anastomoses with the diverticular apparatus, or the main biliary pathway in palliative surgery.