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Indications

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This procedure may be utilized in poor-risk patients having a limited life expectancy because of inoperable malignant disease obstructing the common duct that cannot be decompressed with endoscopic retrograde cholangiopancreatography (ERCP) or transhepatic cholangiopancreatography (THCP) passage of a stent. The cystic duct must be opened and the common-duct malignancy should be quite low, with an expectation that the process will not reach the cystic duct region for several months. In making this short-circuiting anastomosis, it is preferable to utilize the nearest portion of the upper gastrointestinal tract that can be approximated easily to the gallbladder without tension. This is usually the mobilized duodenum or a direct anastomosis to the upper jejunum may be done. If long-term survival is anticipated, the gallbladder or common duct is anastomosed to a Roux-en-Y arm of mobilized jejunum. A cholecystogastrostomy is done rarely. However, the technique shown is more frequently used to anastomose the gallbladder to the duodenum. The gallbladder should not be utilized in an attempt to relieve obstructive jaundice if the cystic duct is obstructed or if the lower end of the common duct is to be removed in a radical resection. Visualization of the gallbladder and ducts by contrast media may be worthwhile to prove beyond any doubt the site of obstruction.

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Preoperative Preparation

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Although the operation is a simple one, the patients are such poor risks that they require careful preparation to avoid fatality. Nutritional needs may require total parenteral nutrition (TPN) support. As a rule, the patient is ...

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