A new method in bile duct-intestine anastomosis: teloscopic anastomosis

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