Indications for surgical creation of biliary-enteric anastomosis (BEA) have been significantly reduced by improvements of interventional endoscopy (sphincterotomy and biliary endoprosthesis placement), especially in patients with malignant obstructions and choledocholithiasis. However, surgery is still indicated when the CBD is larger than 1.5 cm, when large stones occupy the CBD, and when tight and extensive stenosis of the papilla are present, especially in the long-term treatment of elderly patients. Selecting the intestinal segment to use in performing BEA is still controversial and seems to depend on the experience of the surgeon rather than on any really objective criteria. The indications for performing BEA include Mirizzi’s syndrome (0.5%–2% of choledocholithiasis ) and benign stenosis of the CBD due to iatrogenic lesions. These have recently increased in number as a consequence of the greater use of laparoscopic cholecystectomy.
KeywordsBile Duct Hepatic Duct Abnormal Liver Function Test Intrahepatic Duct Bile Duct Obstruction
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- 2.Bismuth H, Lazorthes F (1981) Les traumatismes operatoires de la voie biliare principale. Masson, ParisGoogle Scholar
- 3.Bismuth H (1982) Postoperative stricture of the bile duct. In: Blumgarth LM (ed) The biliary tract. Churchill Livingstone, Edinburgh, pp 209–218Google Scholar
- 5.Machado MCC, Monteiro Da Cunha JE, Bacchella T (1986) A modified technique for surgical repair of cicatricial stenosis of the bile duct. Surg Gynec Obstet 162: 283–284Google Scholar
- 7.Voiles CR, Blumgart LH (1982) A technique for the construction of high biliary-enteric anastomoses. Surg Gynecol Obstet 154: 885–887Google Scholar
- 8.Huguier M, Houry S, Lacaine F, Pascal G (1986) Les anastomoses choledoco-duode-nales dans la lithiasesa biliaire. J Chir 123: 3–6Google Scholar
- 18.Tidmore H, Ram MD (1985) Scintiscanning in the evaluation of biliary-enteric anastomoses. Ann Surg 51: 158–161Google Scholar
- 19.Palmer Gold R, Price JB (1980) The thin needle cholangiography as the primary method for the evaluation of the biliary-enteric anastomosis. Radiology 136: 309–316Google Scholar
- 20.Papp J, Tulassay Z, Bielawski J et al (1977) Diagnostic value of endoscopic retrograde cholangiopancreatography in bilio-digestive anastomoses. Acta Hepatogastroenterol 24: 41–43Google Scholar
- 24.Pavone P, Laghi A, Catalano C et al (1995) Three-dimensional MR cholangiography: a unique diagnostic procedure for evaluation of bile ducts in patients with biliary-enteric anastomoses. Radiology 197: 312Google Scholar