This retrospective study provides an overview of 28 patients (24 dogs and 4 cats) with extrahepatic biliary obstruction that underwent cholecystoduodenostomy with a technique using staples rather than the traditional mucosal appositional technique that uses a simple continuous, absorbable, monofilament suture. The use of surgical staples reduced inflammation and trauma from manipulation of the bowel and provided increased tensile strength at the incision compared with traditional sutures. The procedure was performed to relieve extrahepatic obstruction caused by pancreatitis; cholangiohepatitis; hepatic cirrhosis; pancreatic abscess; and various neoplasias. Survival rates were reportedly 64%, with 2 of the 4 cats being euthanized within 1 week of surgery and 7 of the 24 dogs being euthanized. One dog died and another was euthanized shortly after surgery as a result of complications associated with hypotension and multiple organ failure. Postoperative hypotension was significantly associated with mortality in this study, which was consistent with results of other such retrospective trials. Improvements in various serum biochemical parameters were seen in 18 surviving animals, but long-term follow-up of values or ultrasonographic images of the liver and surgical site was not available for this study. Overall, average if not above-average survival was reported with the stapling technique, associated with shorter surgical times and reduced tissue trauma and inflammation. Complications of stapling were similar to those of the suture technique, as only 3 dogs had postoperative signs of peritonitis.
COMMENTARY: In general, extrahepatic biliary obstruction should only be treated by trained specialists because of the high morbidity and mortality associated with the disease. Owners should be informed that the prognosis for long-term survival is guarded, although it is likely that survival is not associated only with the surgical repair but also with the underlying disease process and the health of the animal at the time of treatment. This was an excellent retrospective study because the surgical technique performed in all 28 cases was controlled, which makes comparison among outcomes easier. Although stapling is a more expensive technique and requires expertise, it shows promise as a superior way to treat extrahepatic biliary obstruction.
Retrospective study of 28 cases of cholecystoduodenostomy performed using endoscopic gastrointestinal anastomosis stapling equipment. Morrison S, Prostredny J, Roa D. JAAHA 4:10-18, 2008.