Technique and endoscopic monitoring of the healing process in bilioenteric anastomoses

Thirty-three patients were given cholangiojejunoanastomoses: 13 for benign postoperative stenoses of the biliary tract (BT) with or without lithiasis; five for massive intra and extra-hepatic lithiasis; 15 for malignant stenoses on the upper third of the biliary ways. The 15 patients in Group A were given a muco-mucosal anastomosis and the 18 in Group B extramucosal anastomosis after excision of the excess mucosa on the jejunotomy. In both groups an interrupted suture using fine, slow-absorption thread was employed. Three patients (two from Group A and one from Group B) were excluded from the study due to postoperative filtration of the anastomosis. Transhepatic cholangioscopic monitoring of the healing process on the 15th, 20th, 30th and 40th day showed that while both types of anastomosis were equally secure, the extramucosal suture after excision of excess mucosa produced wider anastomoses and is therefore advisable in all cases of bilioenteric anastomosis (BEA) but especially when the biliary ways are narrow or tendentially thin-walled.