Stapled cholecystojejunostomy for palliative treatment of the malignant jaundice; an effective and feasible alternative to hand-sewn method.

Unresectable periampullary cancer is commonly characterized by painless jaundice and has a rapid evolution with dismal prognosis. Biliary drainage can be achieved by various techniques and approaches, with the endoscopic drainage being the preferred method. However, when open surgery is performed with the intent to resect a tumor which is finally found to be unresectable, open drainage of the biliary tree is indicated. We present a new technique of cholecystojejunostomy using a circular mechanical stapler, which could be used in patients with intact gallbladder and widely patent the cystic duct. The described cholecystoenterostomy with the use of a circular mechanical stapler is the first reported in the literature. The procedure has been successfully used in 6 patients with excellent results. No early recurrence of biliary obstruction, cholangitis or post-operative anastomotic complications were observed. The relative simplicity of the procedure, the shorter operative time and the effective relief of jaundice, are the main advantages of the proposed technique. We believe that this method needs further investigation and can be proved effective in reducing hospitalization and anastomotic complications, compared to hand-sewn techniques.