A New Surgical Technique of Biliary Drainage

Abstract

Introduction: Roux-en-Y Hepatico-jejunostomy is the standard technique of biliary reconstruction after excision of choledochal cyst. Here the author describes a new surgical technique of biliary reconstruction using native gall bladder as biliary conduit. New Surgical Technique: The choledochal cyst is excised as standard technique but gall bladder with its neck is kept in situ. The gall bladder neck is anastomosed with the common hepatic duct stump and gall bladder fundus is anastomosed with the antero-inferior wall of the first part of distal duodenum. Materials & Methods: Eleven patients with choledochal cyst have been operated with the new technique from July 2011 to December 2012 in the city of Dhaka, Bangladesh. Feeding was started from 3rd post-operative day and drain was removed by 7th day unless complicated and they were released from the hospital between 10-15 days. Results: The ages of eleven patients were from 3 months to 11 years. There were 7 females and 4 males. Lump was felt in 3 patients and jaundice was present in 4 patients. Recurrent abdominal pain was present in all patients. They were diagnosed by ultrasonography and MRCP was done in 6 patients only. Prothrombin time was elevated by 10% & 15% in 2 patients. Average operation time was 2 hours and 10 minutes. A 9-year girl died suddenly and unexpectedly on the 5th post-operative day from severe convulsion of unknown origin. One child suffered from prolonged bile leakage and re-explored to repair anastomotic leak. Another patient had a collection near the anastomosis which resolved spontaneously. Discussion: Benefits of the new surgical technique are total absence of Roux-en-Y related intestinal complications. Possible disadvantages are discussed. It is anatomical and physiological. Small incision and less operation time are other benefits which need to be mentioned. Possible disadvantages are discussed.