Carl Westcott, MD. Wake Forest Medical Center , Winston-Salem, NC.
Illustrations by Rob Flewell.CMI
The majority of biliary bypass procedures are performed for palliation of unresectable malignant biliary obstruction. Surgical bypass is considered superior to endoscopic stenting when the patient is expected to survive for longer than 6 months. An endoscopic cholecystojejunostomy can be performed when a laparoscopic exploration reveals unresectable disease, or after metastatic disease is confirmed by preoperative imaging. Choledochojejunostomy is another surgical option for biliary drainage. In comparison, cholecystojejunostomy is more a more feasible laparoscopic procedure. It is less invasive procedure, and associated with shorter operative time, postoperative convalescence and lower complication rates. To it's discredit, cholecystojejunostomy is not as durable as choledochojejunostomy and is not applicable to those patients with out a gallbladder or patent cystic duct. When combined with laparoscopic exploration and duodenal bypass, metastatic peripancreatic cancer is often staged and palliated with out an abdominal incision. This chapter describes the authors technical experience with and recommendations for performing laparoscopic cholecystojejunostomy.
The surgeon and assistant can either stand on the same side or opposite sides of the table of the table.
The patient is supine with arms extended on arm boards.
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1. Late obstruction of cholecystojejunostomy is reduced by only performing the procedure on those patients that have a greater than one centimeter distance of unobstructed common duct between a patent cystic duct and the obstructing tumor mass. If these conditions cannot be met an open choledochojejunostomy is indicated.
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