Repair of Injury to the Common Bile Duct

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THIS report is based on a survey of the results of 69 operations for repair of injuries to the common bile duct. The operations were performed at the Cleveland Clinic Hospital during the 15-year period from 1940 to 1955 and included hepaticoduodenostomy as well as more complicated procedures.

There is little agreement among surgeons as to which technic of reconstruction of the common bile duct provides the best results. Cole and associates1,2 advocate the use of Roux-Y procedures, which they expect to produce good results in 90 per cent of the cases if from 2 to 3 cm. of duct is available for anastomosis, and if the surgeon himself is “satisfied” with the operation. However, if the proximal stump of the duct is short, Cole believes that only about 65 per cent of the results will be good. In Cole’s cases the over-all results of hepaticojejunostomy, including those operations in which the surgeon himself was “not satisfied” at the end of the procedure, were satisfactory in 79 per cent of the cases. Ravdin3 believes that an end-to-end anastomosis should be made. Aust and Varco,4 reported that in their series of 70 adult patients, surgical results were satisfactory in 48 patients. Best results (satisfactory in 9 of 10) were obtained with hepaticojejunostomy.

Walters5 states that for repair of injury to the common bile duct, hepaticoduodenostomy has been the most effective procedure at the Mayo Clinic. Boren and Walters6 reported that of 147 patients who underwent hepaticoduodenostomies in the last 30 years,. . .



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