EVALUATION OF CHOLEDOCHOJEJUNOSTOMY WITH SUBCUTANEOUS JEJUNOSTOMY FORTREATMENT OF INTRAHEPATIC STONES

Twenty-nine patients, 16 males and 13 females, with intrahepatic stone s were treated by choledochojejunostomy with subcutaneous jejunostomy after choledocholithotomy in cases where the common bile duct was dila ted more than 2 cm in diameter. This surgical technique consists of pu tting a segment of jejunum in the subcutaneous area with a jejunostomy after finishing the choledochojejunostomy. If the stone recurs years later, this loop or jejunum will offer a route for inserting the scope while producing the fistulotomy under local anesthesia. These patient s became symptomless soon after removal of the residual stone by posto perative choledochoscope. After more than five years of follow-up stud y, seven cases (24.1 %) had reflux cholangitis and among them, four pa tients had recurrent stones. Reopening of the fistulotomy was carried out under local anesthesia, and the choledochoscope was inserted into the bile duct through the jejunum for removal of those recurrent stone s. We believe that this surgical technique is very effective for the t reatment of patients with recurrent intrahepatic stones without the ne cessity of major laparotomy.