Technique of laparoscopic cholecystojejunostomy with a Roux-en-Y loop

In order to avoid 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 tested in adult pigs who had undergone 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 prototype 33-mm-diameter trocar, used to effect the proximal and distal anastomoses. Seven pigs operated on in this way recovered easily, with normal weight gain and without technical complications. Contrast radiography of the biliary bypass at autopsy on day 28 confirmed patent and leak-free anastomoses and functional bypass. We conclude that laparoscopic cholecystojejunostomy with a Roux-en-Y loop is a feasible technique and results in an uncomplicated postoperative course and a biliary bypass with optimal function. Endoscopic application of circular staplers for laparoscopic enterobiliary and enteroenteral anastomosis is practical and safe.