Henry Ford Hospital Medical Journal


Retrospective analysis of 70 patients who underwent biliary bypass operations for benign disease over an eight-year period was undertaken to evaluate long-term complications. Operative procedures included choledochoduodenostomy in 60 patients, choledochojejunostomy in four, and cholecystoduodenostomy, cholecystojejunostomy and hepaticojejunostomy in two patients each. The most common indication for surgery was choledocholithiasis, with or without hepatic stones, viscid bile, and ampullary stenosis (61 to 70 patients). Other indications included chronic pancreatitis, choledochal cyst, and sclerosing cholangitis. One patient died postoperatively from hemorrhage, and two others died from causes unrelated to surgery. Two patients developed cholangitis without reflux and demonstrated anastomotic stenosis at re-operation. Sixty-four patients in the series had reflux but remained asymptomatic. Our study supports the concept that cholangitis results from relative obstruction of the anastomosis rather than from reflux.