Surgery: Current Research

ISSN - 2161-1076


Fistulojejunostomy in the Management of Chronic External Biliary Fistula

Kemal Atahan, Atilla Çökmez, Evren Durak and Ercüment Tarcan

Aim: We have recently used an alternative surgical method to resolve external chronic refractory biliary fistula
(ECRBF) and in this article we described our experience with external chronic refractory biliary fistula.
Methods: We reviewed the records of patients who underwent ECRBF between 2000 and 2009. Since conservative
or endoscopic management methods were not useful, fistulojejunostomy was the treatment of choice for these patients.
Patients’ demographics, operation details, clinical and pathological findings and follow up data were retrieved.
Results: We identified 12 patients (7 were female and 5 male, with a mean age of 47 years; range, 33 to 64 years)
who had external chronic refractory biliary fistulas managed by fistulojejunostomy. All patients were admitted with
obvious external bile fistulas with an average duration of 24 weeks (range 20 to 36 weeks). The fistulas were confirmed
by PTC fistulography, ERCP and also MRCP in all patients. The fistulas occurred following cholecystectomy and
bile duct exploration in 5 patients, liver hydatic surgery in 3, choledochojejunostomy anastomotic leak after Whipple
procedure in 2 and liver trauma in 2 patients. The mean fistula output was measured as 573 cc per day. Follow up time
is 49 weeks average.
Conclusions: In this report we described our experience with fistulojejunostomy in the treatment of external
chronic refractory biliary fistula when conventional surgical and minimal invasive approaches fail. Fistulojejunostomy
can be considered as a viable alternative for the patients with external chronic refractory biliary fistula in those cases
not amenable for conventional surgical or mininvasive procedures.