Biliary-enteric anastomosis malfunction: retrospective study of 20 surgical cases. Review of literature

INTRODUCTION: This retrospective study of 20 procedures for malfunction of a biliary-enteric anastomosis include 7 choledochoduodenal anastomosis (CD) and 13 choledocho- or hepaticojejunal anastomosis (HJ). METHODS AND RESULTS: The malfunctions were revealed by angiocholitis (N=16) jaundice (N=4) acute abdominal syndrome (N=1). Among the 7 CD, the median waiting period before reoperation has been 14 years, the procedures were justified by a biliary disorder in 5 cases (1stricture, 4 stones or food obstruction) or by a duodenal stricture (2 cases). The CD have been converted into HJ. The operative mortality was null, the morbidity rate was of 14%. A recurrence of angiocholite occurred in the long-term followed-up. About HJ, the waiting time before reoperations was 6 years and 9 months, the procedures were justified by anastomotic anastomosis stricture (7) calculi without stricture (4) Roux-en-Y limb anomalies (2). Two Roux-en-Y limbs have been lengthened. The anastomoses have been redone when necessary. The side-to-side HJ were converted in end-to-side HJ. The operative mortality was null, the morbidity rate of 8%. In the long term followed-up, 2 stenosis recurrence and 1 lithiase recurrence occurred. CONCLUSIONS: Malfunctions of biliodigestives anastomosis are revealed by angiocholitis that can lead to secondary biliary cirrhosis. The complications treatment of CD is easy and effective. The complications evolution of HJ depends of initial pathology.