[Spur valve jejunal interposition in choledochus cystectomy].

During 1983-1990, 113 patients with congenital choledochus cysts were operated upon with the procedure called the spur valve jejunal interposition following total cystectomy, and satisfactory results were recorded in two years follow-up. However, early complications happened in 26.5% patients e.g. postoperative bile leakage, blood vomiting, small intestinal intussusception, adhesive intestinal obstruction, chyliform ascites, and disruption of wound. Six months-2 years after operation, reflux into bile duct and rapid emptying were observed in some cases in barium examination, and abdominal pain was found in 10% of the patients. The latter was probably due to bile gastritis, which never occurred in conventional Roux-y. An experimental study showed two types of reflux into artificial bile duct. Reflux due to intestinal distention should be checked by an one way valve, while reflux due to normal peristalsis of intestine would be naturally prevented by the intrabiliary pressure formed by the normal bile flow in a narrow bile duct. A spur valve serves an one way stopper and makes the artificial bile duct narrow. In conventional Roux-y, the biliary drainage limb (the artificial bile duct) is the natural path from the distal jejunum while the duodenal drainage limb is just a side-path of the G. I. tract. A wedge anastomosis designed for Roux-Y may convert the natural and side path relationship of the two drainage limbs and would be benefit to avoid reflux into the artificial bile duct.