The appraisal of biliary drainage for intrahepatic gall stones, with special reference to an end-to-side hepaticojejunostomy

Between 1961 and 1983, eighty-six patients with intrahepatic gall stones were identified from a group of 1,140 patients admitted for cholelithiasis. Surgical procedures performed in this series were 37 choledochotomies with external biliary drainages, 33 transduodenal papilloplasties, 37 bilioenteric anastomosis and 15 hepatectomies. In the long term follow up studies after surgical treatment by each procedures, the favorite results were obtained in 41.2% of cases with choledochotomies with external drainages, in 34.4% of cases with transduodenal papilloplasties, in 82.4% of cases with bilioenteric anastomosis and in 88.7% of cases with hepatectomies. Hepatectomy seemed to be a most effective treatment for the prevention of recurrence of stones. However, if the calculi were in the right or both of hepatic lobes, hepatectomy might be a high risk operation and technical proficiency were required in operation. In such cases, we performed an end to side anastomosis between the common hepatic duct and the jejunum (Roux en Y anastomosis) for the postoperative endoscopic lithotomy. In this operation the jejunal stump was made to be an enterocutaneous fistula for the later percutaneous endoscopic lithotomy. This operation has the following advantages; 1) the time of operation were shortened in the removal of stones because of this operation were performed for the postoperative endoscopic lithotomy, 2) retrograde cholangitis was less likely to develop than other operations, 3) retained stones dropped into bowel easily by making a big anastomotic stoma, 4) the cholangioscope could be inserted into either bile ducts of the right and left hepatic lobes, 5) the fistula would be able to be reused for the endoscopic treatment at later recurrence of intrahepatic gall stones.