Anti-refluxing Roux-en-Y biliary drainage valve for hepatic portoenterostomy: animal experiments and clinical experience.

In five dogs, we have created an anti-refluxing Roux en-Y jejunal anastomosis by removing the antimesenteric half of the seromusculature from five cm of the biliary limb proximal to the anastomosis prior to coating the gastric and biliary limbs. In the presence of increasing intraluminal pressure in the gastric and vertical limbs of the Y, the wall of the biliary limb collapses and occludes the lumen, acting as a nonrefluxing one-way valve. All three limbs of the Y were then exteriorized as enterostomies. Saline was instilled into either the gastric or distal limb with the other clamped. There was never reflux from the biliary limb despite intraluminal pressures of 200 mm Hg. We have used the anti-refluxing valve in seven infants. Three are alive at 17, 7, and 2 months postoperatively, one of which had a brief episode of fever without leukocytosis or increasing jaundice. Three have died of unresolved obstruction and one has been lost to follow-up.