A new operative technique for benign biliary stricture – Reconstruction of the common bile duct using free vascularized appendix to preserve function of the papilla of vater – *
To date, Roux-en-Y hepaticojejunostomy has been widely performed to treat benign or malignant biliary strictures. However, complications such as cholangitis and peptic ulcer, attributable to the loss of function of the papilla of Vater, have been frequently encountered after this procedure. To overcome these problems we devised a new operative technique for biliary reconstruction which preserves the function of the papilla of Vater. Using adult dogs, weighing 10 to 15 kg, we created a free appendix with base attaching vessels and cut approximately 1 cm of the central part of the common bile duct. The appendix was interposed between the resected common bile duct, and the appendiceal vessels were anastomosed to the branches of the left gastric vessels. Five dogs were sacrificed at one, two and three years after operation. The transplanted appendix could not be observed in three dogs, and fistulation was noted between the gallbladder and bile duct. However, in the other dogs the free vascularized appendix was confirmed at the interposed site. Cholangiography revealed no fistula formation within the gallbladder, dilatation of an intrahepatic bile duct or stenosis at the site of anastomosis. The outflow of the contrast medium from the papilla of Vater was good. Biochemical examinations disclosed mild liver dysfunction, but total bilirubin was within normal range. Pathologically, in two cases of common bile duct reconstruction using the free vascularized appendix, no chronic inflammation or mucosal dysplasia was observed in the upper and lower bile duct and gallbladder, even at the site of anastomosis between the bile duct and appendix. No inflammatory changes in the liver or pancreas were noted, and no peptic ulcers were seen. A control group was made for the Roux-en-Y hepaticojejunostomy. Five dogs were sacrificed at one or two years after operation by the Roux-en-Y method. Cholangiography showed no dilatation of the bile duct or stenosis at the site of anastomosis in any of the Roux-en-Y method group, and no peptic ulcers were observed in any of the group. Pathologically, ascending cholangitis was confirmed in all dogs in the Roux-en-Y method group. In conclusion, our operative technique using free vascularized appendix as a biliary reconstruction method can preserve the function of the papilla of Vater and it shows possibility as a new surgical procedure. (Accepted on October 18, 2000) Kawasaki Igakkaishi 26(4) 249―258, 2000
