CUTANEOUS STOMA IN THE ROUX LIMB OF HEPATICOJEJUNOSTOMY (HEPATICOCUTANEOUS JEJUNOSTOMY) - USEFUL ACCESS FOR INTRAHEPATIC STONE EXTRACTION

A cutaneous stoma in the Roux limb of hepaticojejunostomy (hepaticocut aneous jejunostomy) was used for stone extraction in two children who had hepatolithiasis (14.5 and 15.5 years, respectively) after operatio n for choledochal cysts. In constructing the hepaticocutaneous jejunos tomy, a short, straight proximal limb from the skin to the bilioenteri c anastomosis is mandatory. It provides a pathway, superior to the T-t ube tract, for repeated stone extraction, which can be performed under sedation, thus obviating repeat laparotomies. The stoma allows flexib le choledochoscopy, balloon dilatation of intrahepatic duct strictures , and extraction of intrahepatic stones using grasping forceps, basket s, and balloons. The electrohydraulic lithotriptor may be applied to f ragment larger stones. Copyright (C) 1996 by W.B. Saunders Company