What is a choledochojejunostomy?
A choledochojejunostomy is a surgical procedure to make a connection (anastomosis) between the common bile duct and the jejunum, which is the middle portion of the small intestine. This technique is called the Roux-en-Y choledochojejunostomy.
The common bile duct is the tubular channel that drains the bile from the liver and gallbladder, through the pancreas, into the duodenum, the beginning portion of the small intestine. Bile helps in digesting fats and fat-soluble vitamins in the small intestine.
An alternative procedure is choledochoduodenostomy, which creates an anastomosis between the common bile duct and the duodenum.
A choledochojejunostomy may be performed as
- Open surgery: The surgeon makes a long, midline or right incision and uses surgical tools typical for performing open abdominal surgeries.
- Laparoscopic surgery: The surgeon makes a single or several tiny incisions. The surgeon then performs the procedure with tiny surgical tools inserted through a flexible tube with a lighted camera (laparoscope).
- Robotic laparoscopic surgery: A robot operates the tiny surgical tools in the laparoscope. The surgeon uses a computer terminal to direct and control the robotic equipment.
Why is a choledochojejunostomy performed?
Choledochojejunostomy procedure may be curative in the case of benign strictures, and palliative to relieve symptoms in malignant diseases. Choledochojejunostomy is performed in situations that include:
- Common bile duct obstruction due to malignant tumors originating in the
- biliary tract
- Obstruction in the common bile duct due to
- In association with a gastrojejunostomy (an anastomosis created between the stomach and jejunum) to prevent potential gastric outlet obstruction
- After liver transplantation
- Injury to the biliary system
How is choledochojejunostomy performed?
Prior to a choledochojejunostomy, the patient may be required to undergo
- Blood, urine, and imaging tests.
- Specific imaging tests for biliary anatomy, such as magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
- A procedure to decompress the biliary system in the case of complete obstruction or presence of jaundice, known as percutaneous transhepatic cholangial drainage (PTCD).
- Correction treatment in the case of blood coagulation disorders because of liver dysfunction.
- A course of antibiotics for infection.
The patient must
- Avoid eating or drinking 8 hours prior to the procedure.
- Check with the doctor before taking any regular medications.
- An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the procedure.
- The patient is intubated to provide oxygen.
- The surgeon makes one or more incisions in the abdomen depending on the type of surgery.
- The surgeon cuts the jejunum about 25 cm to 30 cm from the end of the duodenum.
- The lower section of the jejunum is taken up to the common bile duct.
- The surgeon severs the common bile duct above the level of obstruction and connects it to the jejunum with sutures.
- Bile fluid is removed for a culture test.
- The upper section of the severed jejunal tract is connected to the jejunum farther down.
- A stent is placed for bile drainage.
- The abdominal muscles and the incision are closed with sutures.
- The patient is brought out of anesthesia and administered painkillers for post-surgical pain.
- The patient will be monitored in the recovery room for several hours.
- The patient may need hospitalization for up to a week depending on the type of surgery.
- Complete recovery may take up to 6 weeks during which period the patient may need
- To be on a special diet
- Avoid heavy lifting
- Avoid strenuous activities
- Patients with malignancies may need continued treatment.
What are the risks and complications of choledochojejunostomy?
Complications associated with choledochojejunostomy include the following:
Side effects of anesthesia such as
Surgical risks such as:
- Wound infection
- Blood clots
- Damage to nearby organs, blood vessels or nerves
- Anastomotic leakage or stricture
- Biliary drainage tube dislodgement
- Collection of bile fluid in the abdominal cavity (biloma)
- Inflammation of the stomach lining (peritonitis)
- Inflammation of the common bile duct
- Abdominal abscess
- Lower common bile duct stump leak
- Incisional hernia
- Infection and sepsis