A subcutaneous or subfascial jejunostomy is beneficial in the surgical management of extrahepatic bile duct cancers

Background. Extrahepatic bile duct cancers are rare tumors with a dismal pr ognosis. Even after a resection, obstructive cholestasis and other biliary complications are the rule. To facilitate retrograde access to the biliary tree for treatment of such biliary complications, a modified Roux-en-Y hepa ticojejunostomy is constructed such that the afferent limb is brought up as a subcutaneous or subfascial jejunostomy (SJ). The safety and utility of c onstruction of an SJ was evaluated in patients with extrahepatic cholangioc arcinema. Methods. From 1985 to 1997, 24 patients with extrahepatic bile duct cancers received an SJ as part of their management. Demographic data, operative da ta, tumor characteristics, and postoperative courses were retrospectively r eviewed All but 3 patients were followed to the time of death. Results. The average age of the patients was 62 +/- 9 years. The turner was resected in 17 patients. Major complications occurred in 5 patients (21%). There was I operative death (4%). None of the complications could be attri buted to construction of the SJ, although I patient had a soft tissue infec tion at the site of the percutaneous access of the SJ. Frequent dilatations of biliary strictures were required in 5 patients, and 1 patient eventuall y required insertion of an internal biliary stent. These procedures could a ll be accomplished through the SJ. Conclusions. The SJ is a technically simple and safe addition to the manage ment of resectable and unresectable extrahepatic bile duct cancers, particu larly proximal lesions. The procedure facilitates brachytherapy if indicate d, and it allows convenient management of postoperative biliary complicatio ns, including recurrent strictures.