Reconstruction of the biliary tract using biliary-duodenal interposition of a defunctionalized jejunal limb

Interposition of a defunctionalized limb of jejunum between the confluence of the hepatic ducts and the duodenum seems to have some advantages. Biliary-jejunal anastomosis can be performed in a wider diameter, if necessary; duodenal function is kept almost normal, and the isolated segment of jejunum prevents the duodenojejunal reflux from getting to the biliary tract. The records of 19 patients upon whom hepatico-jejuno-duodenostomy was performed were reviewed. Seventeen patients had iatrogenic lesions and benign strictures of the common bile duct. Two patients had malignant tumors of the common bile duct. The postoperative follow-up period ranged from six months to five years. The average postoperative time was ten days. Two transient bile leaks were observed. Two patients had postoperative episodes of cholangitis. In both, the hepatico-jejunostomy was narrow, and stones were found in the intrahepatic position. A new and wider cholangiojejunostomy was performed. All of the patients were investigated roentgenographically after contrast material was given orally. Only two of the patients were found to have an enteric-biliary reflux which partially filled the intrahepatic biliary branches, but this was only observed at the time the abdomen was compressed.