Felis ISSN 2398-2950

Cholecystoenterostomy

Synonym(s): Cholecystoduodenotomy

Contributor(s): Ed Hall, Rachel Burrow

Introduction

  • Creation of a stoma between the gallbladder and duodenum (or jejunum) with biliary diversion.
  • Bile diversion into the duodenum is termed cholecystoduodenostomy, this technique is preferred as it is the most physiological.
  • Bile diversion into the jejunum is termed cholecystojejunostomy.
  • Dehiscence of the anastomosis is an early and serious surgical complication as it results in peritonitis Peritonitis.
  • The likelihood of dehiscence is reduced by ensuring a tension free anastomosis and careful placement of sutures.
  • After the above biliary diversion procedures intestinal contents will enter the gallbladder and the stoma must be of adequate size to allow intestinal contents to move freely in and out of the gallbladder, and for bile to flow freely into the intestines.
  • Stricture of the anastomosis is a late and serious surgical complication.
  •  The likelihood of stricture formation is reduced as above to reduce dehiscence and by creating a stoma of initial size 2.5-4 cm.
  • The stoma is likely to decrease in size during healing by approximately 50%.

Uses

  • To allow biliary diversion in the prescence of obstruction of the common bile duct.
  • Obstruction of the common bile duct may be due to stricture/scarring, inflammation, choledocholiths, neoplasia.
  • To allow biliary diversion in the presence of trauma of the common bile duct.
  • In combination with resection of the pylorus and proximal descending duodenum (Billroth II).

Requirements

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Preparation

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Procedure

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Son T T, Thompson L, Serrano S et al (2010) Surgical intervention in the management of severe acute pancreatitis in cats: 8 cases (2003-2007). J Vet Emerg Crit Care 20 (4), 426-35 PubMed.
  • Morrison S, Prostredny J, Roa D (2008) Retrospective study of 28 cases of cholecystoduodenostomy performed using endoscopic gastrointestinal anastomosis stapling equipment. J Am Anim Hosp Assoc 44 (1), 10-8 PubMed.
  • Buote N J, Mitchell S L, Penninck D et al (2006) Cholecystoenterostomy for treatment of extrahepatic biliary tract obstruction in cats: 22 cases (1994-2003). J Am Vet Med Assoc 228 (9), 1376-82 PubMed.
  • Bacon R J, White R A (2003) Extrahepatic biliary tract surgery in the cat: a case series and review. JSAP 44 (5), 231-5 PubMed.
  • Mayhew P D, Holt D E, McLear R C et al (2002) Pathogenesis and outcome of extrahepatic biliary obstruction in cats. JSAP 43 (6), 247-53 PubMed.

Other sources of information

  • Fossum T W (2007) Surgery of the extrahepatic biliary system. In :Small Animal Surgery. 3rd edn. Ed TW Fossum, Missouri:Mosby Elsevier. pp560-572.
  • Marin R A, Lanz O I, Tobias K M (2003) Liver and Biliary System. In:Textbook of Veterinary Surgery, 3rd edn. Eds D Slatter. Philadelphia: W.B. Saunders. pp 708-726.


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