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A new method in bile duct-intestine anastomosis: teloscopic anastomosis
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H. پیروی   |
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Abstract: (17906 Views) |
| Introduction. One of the most import a nt causes in mortality a nd morbidity a nd
outcome of liver transplantation is the method used for anastomosis of the bile duct to
t he intest ine . Seve ral methods have been used for restoring a norma l bi le flow to th e
in tes t ine amo ng whic h, the mos t important a re ch ol ed och oj eju nost omy and
ch oledochocho ledochos to my.T he most commo n complicatio ns co nfron te d wit h after these ope ra t io ns in clude a nastomosis sit e le akage and ste nos is. For t his reason , widespread research projects a re underway to find an easier and more optimal method fo r bile duct an astomosis in the in testine. In this resea rch, foll owing the cho le docha ledges inside and passing them through an inte stina l intramural cha nnel (the Roux-en –Y anastomosis method), have been studi ed as a method to decrease the incidence of the two common prementioned complications.
Materials and Methods. the common bile ducts were found in 6 sheeps, and with the
help of two 180 degrees sutures, th eir edges were folde d back on the inte st ine, pulled
thro ugh a n in testin al intramural ch annel and with the same two s ut ur e s, wer t e
a nastomosed internally to all of the intestinal layers.
Results. 8 months afte r te losco pic anasto mosis of th e bile du ct to the intest ine, no
sign of sten osis, cholangitis or bacteremia wer e found in 3 cases, a prominent papillary shaped fold was see n in the jejunum. In one case, a leak age site from the anas omosis
wa s detected no le akage was detected o n the 3rd day in th e lap a r a tomy. T he
anastomosis was found in another case on the 14th day for the purpose of histological
examinati ons both macroscop ic and microscop ic repair process was normal.
Conculsion. The r es ul ts o f the study s ugges t tha t in the R oux- en- Y
choledochojejunostomy method, fewer number of bacteria reach the common bile duct
(C.B.O) however, the direct anastomosis of CBO to the jejunum is as socia te d with a
higher incid enc e of bacteremia and stenosis. F olding the CBO edges inside -ou t,
associa t e d with decre ased number of sutures joining the duct to the intest ine.
Introduction of the duct to intestine through an intestinal intramural channel and finally,
formation of a papillary fold or prominence, all could be seen? promising approaches to
overcome the difficulties encountered in a classic bile duct anastomosis |
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| Keywords: Teloscopic Anastomosis, Common bile duct, Intestine |
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Full-Text [PDF 1095 kb]
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Type of Study: Research |
Subject:
General
Received: 2009/01/17 | Published: 2000/11/15
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