Abstract
In order to assess the patency and function of biliary-enteric anastomoses performed in our Department of Surgery, 21 patients entered the following study, provided an informed consent was obtained. All the patients were affected by benign biliary tract diseases and underwent either Roux-en-Y hepaticojejunostomy (11 cases), or side-to-side choledochoduodenostomy (10 cases). The 21 patients were evaluated with Tc-99m-HIDA scanning at intervals of 20 days–36 months after the surgical procedure (mean 14 months). The images were obtained after intravenous injection of the radioactive medium (5 mCi) and the scans were taken at 1 min (1 frame/s), 3 min (1 frame/10 s), and 56 min (1 frame/2 min). The data were analyzed by a Digital PDP 11/34 Computer System. This method allowed us to assess each individual patient for the patency of the anastomosis and, by computer analysis, to build up a profile of the timing of the passage of the radioactive medium through the anastomosis; a delayed passage across the anastomosis was always pathological. In conclusion, the 99m-Tc-HIDA scanning used in our study for long-term follow-up of biliary-enteric anastomoses is reliable and allows an assessment of prognosis.
Highlights
Hepaticojejunostomy (HJ) and choledochoduodenostomy (CD) represent the most commonly used biliary enteric anastomoses for cholelithiasis and bile duct reconstructive surgery
Bad long-standing preoperative stasis resulting in bile duct dilatation that may persist after the operation without affecting the anastomotic function
Presence of air or reflux of barium into the biliary tree demonstrated during an upper gastro-intestinal series is not conclusive evidence of good anastomotic function in patients with choledochoduodenostomy
Summary
Hepaticojejunostomy (HJ) and choledochoduodenostomy (CD) represent the most commonly used biliary enteric anastomoses for cholelithiasis and bile duct reconstructive surgery. Complications are relatively common; leakage and anastomotic breakdown usually present early on, whereas stenosis and cholangitis occur months or years after surgery[2,3,4]. The incidence of postoperative stenosis has been reported as 0.8-23% 4 There is considerable variability in the criteria chosen to assess the long-term results of biliary by-pass operations2’5’6: the follow-up usually reported is too short (< 2 years) and, even when adequate follow-up is provided, an objective method of assessing the long-term patency and function of biliary anastomosis is lacking. Cholescintigraphy with Tc-99m-labeled analogue of iminoadiacetic acid (HIDA), introduced for the diagnosis of suspected acute cholecystitis, is being successfully applied in the evaluation of the postoperative
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