[Bilio-digestive anastomosis by means of bilio-jejuno-duodenoplasty]

There is a conviction that most of the more commonly used surgical procedures for bilio-digestive anastomoses are not quite satisfactory on a long term basis. This is especially true when these anastomoses are performed in such a way that the bile by-passes the duodenum, like using a defunctional jejunal loop with the Roux technique. Such by-pass techniques inevitably cause digestive problems which are often undetectable if moderate, or concomitant with more serious troubles of a different kind, but can sometimes be severe. This has emerged from recent researches on digestive physiopathology and it is also evident in the follow up of patients in whom the duodenum has been by-passed. Many workers haved tried to avoid these complications by using where indicated, a jejunal loop interposed between the biliary tract (common bile duct, intra and extra-hepatic biliary ducts) and the duodenum, namely bilio-jejuno-duodeno plasty. This procedure also has the advantage of avoiding or at least reducing duodeno-biliary reflux. It is confirmed that this procedure gives an efficient, functional bilio-digestive anastomosis. A personal technique, which is a modification of bilio-duodenal anastomosis with interposition of jejunal loop, is proposed. The technique gives the same results as bilio-jejuno anastomosis with bile flow through the duodenum and prevention of duodeno-biliary reflux; it is also simpler and faster.