[Laparoscopic Y-Roux anastomosis]

In order to circumvent laparotomy in patients with biliary obstruction due to inoperable carcinoma of the pancreatic head, we evaluated the feasibility of a bypass operation using minimal invasive measures. A technique of laparoscopic cholecystojejunostomy was developed in adult pigs with a previous clip occlusion of the distal common bile duct to imitate choledochal obstruction. Complete biliary bypass was restored with a cholecystojejunostomy via a Roux-en-Y loop using two circular staplers (21, 25 or 29 mm diameter), introduced through a 33-mm-diameter trocar, to perform the proximal and distal anastomoses. 12 pigs operated in this way, recovered easily with normal weight gain and without technical complications. Contrast radiography of the biliary bypass at autopsy on day 28 demonstrated patent and leak-free anastomoses and functional bypass. We conclude that laparoscopic cholecystojejunostomy with Roux-en-Y loop is a feasible technique resulting in an uncomplicated postoperative course and a biliary bypass with optimal function. Endoscopic application of circular staplers to perform laparoscopic entero-biliary and entero-enteral anastomosis is practical and safe.