A Method for the Exclusion of Liver Function.

Abstract

When the patency of the common bile duct is destroyed, as by a stricture, or by the pressure of an inoperable tumor of the head of the pancreas, the surgeon is confronted with an operation of necessity; an exit must be provided for the bile. Various procedures have been suggested, and are applicable according to the actual conditions found in the given case. The most usual procedure is the operation of cholecystenterostomy—a direct anastomosis between the gall bladder and some portion of the digestive tube.

This is a life saving procedure, easily carried out, with quite satisfactory results. Perhaps the only objection is that the pressure within the digestive tube is greater than the pressure in the gall bladder, with the consequence that the intestinal content is forced into the biliary system, with sometimes a final result of dilatation and general cholangitis.

This untoward final result of the accepted operative procedure led to the following: The intestine is sectioned at some suitable point, and the distal end united to the gall bladder by an end-to-end anastomosis (A) with the fundus of the gall bladder. The continuity of the digestive tube is now restored by a suitable end-to-side anastomosis of the proximal end of the tube to the side of the intestine at a point 7 or 8 inches below the end-to-end union between gall bladder and distal intestine (B). The purpose of this procedure is to interpose between the gall bladder and the stream of intestinal content a segment of intestine in which the direction of normal peristaltic activity would act as a one-way valve, tending to prevent the entry of intestinal content into the gall bladder.