Surgical treatment of the patients with pathology of the main biliary duct in duodenal malrotation associated with duodenostasis

Abstract

Background: In a number of patients (5-15% cases) who underwent endoscopic retrograde cholangiopancreatography, despite of reestablishing the biliary flow, biliary pathology persists in the form of mechanic jaundice, chronic cholangitis, choledocholithiasis. The cause is represented by the duodenobiliary reflux in duodenal malrotation associated with duodenostasis and the Vater papilla insufficiency. Material and methods: The study was performed on 110 patients during 11 years (1998-2009) with MBD pathology associated with duodenostasis. A new surgical strategy was implemented which excludes duodenobiliary reflux. It is performed by supraduodenal resection of the MBD and its implantation in an intestinal loop in “Y” a la Roux with the length of 80 cm. Results: This permitted reestablishing of biliary flow without entero-choledocian reflux, decreasing the risc of postoperation complications and a good socio-professional reintegration of these patients. Conclusions: Surgical techniques used before 1998 to treat patients with biliary pathology in duodenal malrotation associated with duodenostasis did not deal with the main aspect of this disease which is duodenobiliary reflux. The new technique which makes use of an intestinal loop in ”Y” a la Roux helped solve this problem.