Interposed Jejunal Loop with Artificial papilla: A New Procedure of Choledocho-duodenostomy / 第三军医大学学报

ABSTRACT

Internal drainage of the biliary tract such as choledocho-duodenostomy or Roux-en-y choledocho-jejunostomy is a common operation for the treatment of primary choledocholithiasis and biliary stricture. Though these operations can creat a good drainage, serious reflux cholangitis is frequently resulted. In order to prevent this tiresome complication, the authors have designed a new operative procedure a loop of jejunum is isolated and an artificial papilla is made on its distal end, then its proximal end is joined to the bile duct and its distal end with the artificial papilla is inserted into the duodenum and the two parts are sutured up.This paper is to report this operative method in detail and our experience with 11 cases. After operation, no reflux of the intestinal content into the interposed jejunal loop was found and barium meal could demonstrate reflux of the contrast medium only in one case out of the 11. Ten cases were followed up from 4 to 18 months and excellent results were observed. It proves that this operative procedure can prevent the reflux of chyme into the biliary tract.Interposed jejunal loop with an artificial papilla is more physiological than Roux-en-y choledochojejunostomy since bile can flow through the interposed jejunum loop into duodenum to mix with the pancreatic fluid and the chyme, which is helpful to better digestion.