Abstract
Background. Extrahepatic bile duct cancers are rare tumors with a dismal prognosis. Even after
a resection, obstructive cholestasis and other biliary complications are the rule.
To facilitate retrograde access to the biliary tree for treatment of such biliary
complications, a modified Roux-en-Y hepaticojejunostomy is constructed such that the
afferent limb is brought up as a subcutaneous or subfascial jejunostomy (SJ). The
safety and utility of construction of an SJ was evaluated in patients with extrahepatic
cholangiocarcinoma. Methods. From 1985 to 1997, 24 patients with extrahepatic bile duct cancers received an SJ
as part of their management. Demographic data, operative data, tumor characteristics,
and postoperative courses were retrospectively reviewed. All but 3 patients were followed
to the time of death. Results. The average age of the patients was 62 ± 9 years. The tumor was resected in 17 patients.
Major complications occurred in 5 patients (21%). There was 1 operative death (4%).
None of the complications could be attributed to construction of the SJ, although
1 patient had a soft tissue infection at the site of the percutaneous access of the
SJ. Frequent dilatations of biliary strictures were required in 5 patients, and 1
patient eventually required insertion of an internal biliary stent. These procedures
could all be accomplished through the SJ. Conclusions. The SJ is a technically simple and safe addition to the management of resectable
and unresectable extrahepatic bile duct cancers, particularly proximal lesions. The
procedure facilitates brachytherapy if indicated, and it allows convenient management
of postoperative biliary complications, including recurrent strictures. (Surgery 2000;127:506–11.)
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Article info
Publication history
Accepted:
January 24,
2000
Footnotes
*Reprint requests: Oliver F. Bathe, MD, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Suite 3550, Miami, FL 33136.
**Surgery 2000;127:506–11
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
