The exoendoprosthesis in proximal bilioenteric anastomoses

Abstract

The exoendoprosthesis is a completely indwelling anastomotic stent with the external end fixed to a reservoir in the subcutaneous tissue. With local anesthesia, cholangiography and tube exchange are possible. The exoendoprosthesis was used in 15 patients with obstruction to the proximal bile duct. The obstructive lesions included cholangiocarcinoma (six patients), pancreatic cancer (two patients), gallbladder cancer (two patients), sclerosing cholangitis (three patients), and benign stricture (two patients). The postoperative course was comparable to similar series with external tubes. In one patient, a persistent bile fistula necessitated early exteriorization of the tube and biliary decompression. If cholangitis or jaundice recurred, the tube was exteriorized and exchanged to be managed conventionally. However 12 months postoperatively, eight patients had indwelling tubes without any incidence of cholangitis or jaundice. The indwelling location of the tube relieved the patients of the burden of tube management and may have reduced the incidence of cholangitis.