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Hepaticojejunostomy without suture

E Bratucu1, D Ulmeanu, D Bota

  • 1Department of Surgery, Caritas Hospital, Carol Davila University School of Medicine, Bucharest, Romania.

Digestive Surgery
|December 9, 1998
PubMed
Summary
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This study introduces a sutureless hepaticojejunal anastomosis technique for common bile duct (CBD) surgery, using a Foley catheter to maintain apposition. This innovative approach is effective in challenging cases with poor anatomical conditions, offering a new option for CBD stenosis treatment.

Area of Science:

  • Gastroenterology and Hepatobiliary Surgery
  • Surgical Innovation
  • Minimally Invasive Techniques

Background:

  • Standard 'a la Roux' hepaticojejunal anastomosis is challenging with narrow or thin common bile duct (CBD) stumps.
  • Poor anatomical conditions, often seen in iatrogenic or malignant CBD lesions, complicate traditional sutured anastomosis.
  • Existing methods may be insufficient when biliary stump quality compromises suture integrity.

Observation:

  • A novel sutureless hepaticojejunal anastomosis technique was developed.
  • This method utilizes a Foley-type balloon catheter to stent and maintain apposition of anastomosis segments.
  • Continuous traction on the catheter facilitates healing over an average of 10 days.

Findings:

  • The sutureless technique was successfully applied in 7 cases of CBD stenosis (4 neoplastic, 3 accidental lesions).

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  • The procedure demonstrated no perioperative morbidity in the treated cases.
  • One fatal outcome was recorded, necessitating further evaluation.

    • Implications:

    • This sutureless method offers a viable alternative for hepaticojejunal anastomosis in challenging CBD anatomies.
    • It may reduce complications associated with suturing in compromised biliary stumps.
    • Further research is warranted to validate the safety and efficacy of this technique in a larger cohort.