J.Jpn. Surg. Soc.. 87(9): 1079-1082, 1986
Report on the annual meeting
CHOLANGITIS AFTER BILIARY RECONSTRUCTION
－PITFALLS AND PROBLEMS OF THE EXCLUDED JEJUNUM－
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First Department of Surgery, Kyoto University School of Medicine, Kyoto, Japan Masaaki Shiota, Takashi Suzuki, Tadao Manabe, Kotaro Uchida, Takayoshi Tobe |
In the follow-up survey, episodes of cholangitis occurred more frequently in Roux-en-Y choledochojejunostomy (R-Y) patients than in choledochoduodenostomy (C-D) patients for cholelithiasis, and also in Child procedure patients than in Imanaga procedure patients after pancreatectomy for periampullary disease. Hepatobiliary scintigraphy demonstrated the prolonged stasis of bile in the excluded jejunum of the R-Y and Child procedure patients who experienced episodes of cholangitis.
In the experimental studies of dogs, the R-Y group of dogs had more severe cholangitis, based on serological and histological examination, than the C-D and loop choledochojejunostomy group. Moreover, chronic myoelectric observation of the excluded jejunum on the R-Y and Child procedure dogs revealed abnormal activity, which may interfere with transit of bile in the excluded jejunum.
Our studies suggest that the excluded jejunum in biliary reconstruction is not useful in respect to prevention of cholangitis and may even become a cause of cholangitis when prolonged stasis of bile occurs in the excluded jejunum.
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