[Extrahepatic biliodigestive anastomoses. Analysis of 227 cases]

The authors analyze their experience with 227 biliodigestive anastomoses to compare the early and late results. Choledocholithiasis (49%) and cancer of the pancreas (25%) were the most common processes. Choledochoduodenostomy (48%), cholecystojejunostomy (22%), sphincteroplasty (18%) and hepaticojejunostomy (9%) were the techniques most often used. In 61% of cases (90% of the malignant tumors) there was an emergency indication. Twenty-one percent of the patients presented serious complications in the postoperative period (14% of the benign tumors), half of which depended on the bypass. Postoperative peritonitis (2%), external biliary fistula (4%) and acute pancreatitis (2%) were the most significant surgical complications. Hepaticojejunostomy induced the largest number of bypass-dependent complications. There were 12 deaths due to medical causes (5%), these being most numerous in subjects with neoplasms and cholecystojejunostomy, and 8 of surgical origin (4%), half of them in carriers of a hepaticojejunostomy. There was a clear decline in the morbidity of patients operated on in recent years. In the long term, 91% of the patients remained free of discomfort or had minimal symptoms. Choledochoduodenostomy or sphincteroplasty produced the best results. It is concluded that biliodigestive anastomoses yield the best early and late results with minimal secondary effects.