Reconstruction of the bile duct with transanastomotic U tubes

Thirty-one adult patients have undergone reconstruction of the bile duct using a transanastomotic U tube to stent biliary-enteric anastomoses. The U tube is brought through the substance of the liver into the proximal part of the bile duct, threaded through the anastomosis, usually to a Roux-en-Y limb of jejunum and then withdrawn from the jejunum through a separate enterotomy. Both ends of the Silastic (silicone rubber) catheter are then brought out the abdominal wall through separate stab incisions and secured to the abdominal wall. In 21 patients, the procedure was performed for benign disease. There were no operative deaths. Recurrent strictures developed in two patients (9.5 per cent). There were seven infectious complications, none of which were life-threatening. Preoperative bilirubin levels averaged 9.5 milligrams per cent; postoperative bilirubin levels averaged 2.6 milligrams per cent. Recurrent stricture developed in two patients at 20 and 19 months after removal of the U tubes. In ten patients, the obstruction of the biliary tract was secondary to malignant disease--seven primary tumors of the biliary tract and three metastatic tumors. Operative mortality was 20 per cent. Among the patients who survived the operation, the average bilirubin level was 6.6 milligrams per cent as compared with the average preoperative level of 14.4 milligrams per cent.