Cholecystojejunocholecystostomy: a new method of biliary drainage in auxiliary liver allotransplantation

A subhepatic, whole auxiliary liver allotransplant technique, previously developed in the pig, was assessed for technical feasibility in 26 human cadaver transplants. All technical aspects of the subhepatic technique were feasible, with the exception of donor to recipient gallbladder-to-gallbladder anastomosis, which could only be performed in 50% of subjects due to excessive separation of the two gallbladders. To oversome the problem, an original technique was developed--namely, the use of an isolated, vascularized, isoperistaltic loop of jejunum to act as a conduit between donor and recipient gallbladders (cholecystojejunocholecystostomy). Cholecystojejunocholecystostomy was subsequently developed and studied in a series of live porcine auxiliary allografts. The local, reginal, and general effects seen in 14 allografted pigs with cholecystojejunocholecystostomy were compared with those seen in a parallel and identical series of 14 allografts with cholecystocholecystostomy. The subhepatic transplantation technique is described in detail for the first time. Liver biopsies, blood samples, and clinical data were obtained at weekly intervals and at 28 days all survivors were killed. Cholecystojejunocholecystostomy proved to be a successful method of biliary drainage in the pig. Thirteen of the 14 interposed jejunal loops were viable and essentially normal at autopsy, leaks and naked eye stasis were infrequent, and the histological incidence of intrahepatic cholangitis and cholestasis minimal. The local, regional, and general effects were comparable in every way with those obtained with cholecystocholecystostomy.