Advertisement

Biliary-Enteric Anastomoses

  • Paolo Pavone
  • Roberto Passariello

Abstract

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 [1]) 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.

Keywords

Bile Duct Hepatic Duct Abnormal Liver Function Test Intrahepatic Duct Bile Duct Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Halleb A, Frileux P, Cohen JP et al (1986) Fistules bilio-biliaires d’origine lithiasique. A propos de huit cas. Ann Chir 40: 363–366PubMedGoogle Scholar
  2. 2.
    Bismuth H, Lazorthes F (1981) Les traumatismes operatoires de la voie biliare principale. Masson, ParisGoogle Scholar
  3. 3.
    Bismuth H (1982) Postoperative stricture of the bile duct. In: Blumgarth LM (ed) The biliary tract. Churchill Livingstone, Edinburgh, pp 209–218Google Scholar
  4. 4.
    Blumgart LH, Kelley CJ, Benjamin IS (1984) Benign bile duct stricture following cholecystectomy: critical factors in management. Br J Surg 71: 836–843PubMedCrossRefGoogle Scholar
  5. 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
  6. 6.
    Pitt HA, Miyamoto T, Parapatis SK et al (1982) Factors influencing outcome in patients with postoperative biliary strictures. Am J Surg 144: 14–18PubMedCrossRefGoogle Scholar
  7. 7.
    Voiles CR, Blumgart LH (1982) A technique for the construction of high biliary-enteric anastomoses. Surg Gynecol Obstet 154: 885–887Google Scholar
  8. 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
  9. 9.
    Bismuth H, Franco D, Corlette MB, Hepp J (1978) Long term results of Roux-en-Y hepaticojejunostomy. Surg Gynecol Obstet 146: 161–167PubMedGoogle Scholar
  10. 10.
    Hepp J, Bismuth H (1966) Accidents et complications precoces de la sphincterotomie odienne. Rev Int Hepatol 16: 497–519PubMedGoogle Scholar
  11. 11.
    Lane CE, Sawyers JL, Riddell DH (1973) Long-term results of Roux-en-Y hepatocholan-giojejunostomy. Ann Surg 177: 714–720PubMedCrossRefGoogle Scholar
  12. 12.
    Stefanini P, Carboni M, Patrassi N et al (1975) Roux-en-y hepaticojejunostomy: a reappraisal of its indications and results. Ann Surg 181: 213–219PubMedCrossRefGoogle Scholar
  13. 13.
    Genest JF, Nanos E, Grundfest-Broniatowsky S et al (1986) Benign biliary strictures: an analytic review (1979-1984). Surgery 99: 409–413PubMedGoogle Scholar
  14. 14.
    Eubanks B, Martinex CR, Mehigan D, Cameron GL (1982) Current role of intravenous cholangiography. Am J Surg 143: 731–733PubMedCrossRefGoogle Scholar
  15. 15.
    Negrin JA, Zanzi I, Margouleff D (1995) Hepatobiliary scintigraphy after biliary tract surgery. Semin Nucl Med 25: 28–35PubMedCrossRefGoogle Scholar
  16. 16.
    Wilson S R, Toi A (1990) Sonography accurately detects biliary obstruction in patients with surgically created biliary-enteric anastomosis. AJR 155: 789–794PubMedCrossRefGoogle Scholar
  17. 17.
    Montalvo BM, Fanney DR, Yrizarry JM, Russell E (1989) Hepaticodochojejunostomy with afferent limb: CT anatomy. Gastrointest Radiol 14: 246–250PubMedCrossRefGoogle Scholar
  18. 18.
    Tidmore H, Ram MD (1985) Scintiscanning in the evaluation of biliary-enteric anastomoses. Ann Surg 51: 158–161Google Scholar
  19. 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. 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
  21. 21.
    Hamilton I, Lintott DJ, Rothwell J, Axon ATR (1983) Acute pancreatitis following endoscopic retrograde cholangiopancreatography. Clin Radiol 34: 543–546PubMedCrossRefGoogle Scholar
  22. 22.
    Morimoto K, Shimoi M, Shirakawa T et al (1992) Biliary obstruction and evaluation with three-dimensional MR cholangiography. Radiology 183: 578–580PubMedGoogle Scholar
  23. 23.
    Guibaud L, Bret PM, Reinhold C et al (1995) Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 197: 109–115PubMedGoogle Scholar
  24. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • Paolo Pavone
    • 1
  • Roberto Passariello
    • 1
  1. 1.Istituto di Radiologia, Cattedra IIUniversità degli Studi di Roma “La Sapienza”RomeItaly

Personalised recommendations