OPEN CHOLECYSTECTOMY WITH CBD EXPLORATION WITH HEPATICOJEJUNOSTOMY

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This is fairly an abnormal situation in which the bile duct is joined with a segment of jejunum after gall bladder removal.

Commonly this procedure is done in some cases of Mirrizzi syndrome in which there will be abnormal communication between the gall bladder and bile duct. In some cases of Mirrizzi syndrome, the bile duct will have the features of chronic inflammation with fibrosis. Here open cholecystectomy will be proceeded and there will be an abnormal communication with gall bladder and some part of bile duct (Cholecysto-Choledochal Fistula). At this stage the fistulous tract will be disconnected. Any stones in the bile duct will be removed. After completing this procedure, next option is the reconstruction of bile duct. In case of bigger fistula as in cases of type III and IV MIrizzi’s syndromes, simple reconstruction will not be possible. So, bile duct fistulous opening will be anastomosed with healthy isolated loop of jejunum. The procedure is known as Roux-en-Y Hepaticojejunostomy. The side of the bile duct will be anastomosed with the side of the jejunum with absorbable sutures using various techniques. This may be a major operation but other alternative techniques are less effective.