A combined surgical and interventional radiology procedure in bile duct obstruction
Surgery for biliary obstruction may be complicated by the presence of intrahepatic stones and, in difficult anastomoses, by the possibility of recurrent stricture formation. In order to decrease the need for further operation, the first surgical repair in selected cases should allow access for later radiological intervention. Primary operation consists of biliary digestive anastomosis using established techniques with a Roux-en-Y-loop. A limb of the Roux-loop may be brought to the abdominal wall and secured to the anterior parietal peritoneum to allow access for later radiological intervention either by utilizing an established tubal tract into the Roux-loop or by later puncture of the loop under ultrasound guidance. Since October 1986 we have treated 11 patients utilizing this technique. Six patients had complex strictures following cholecystectomy and two patients had obstructions secondary to alveolar or cystic Echinococcosis. One stricture was due to a previous liver resection, one followed previous operation for congenital atresia of the biliary tract and one consisted of multiple strictures and stones associated with oriental recurrent pyogenic cholangitis. In all 11 patients, postoperative radiological imaging was possible. In 6 patients, 14 radiological manoeuvers were carried out for dilatation or for removal of stones and debris. There were no complications. During a median follow-up of 11 months no patient needed further surgical intervention. The indications and techniques are outlined.