[Biliary and gastrointestinal bypass: laparoscopic possibilities].

OBJECTIVE

Although surgical biliary bypass for non-resectable peri-ampullary tumors is superior to endoscopic stent placement, the latter has become popular because of its "minimally invasive" approach. Laparoscopic biliary bypass would appear to offer the advantages of both. However, this technique remains technically difficult using existing instrumentation. In this paper the efficacy of a new endoscopic device designed for rapidly completing a small diameter intestinal anastomosis under laparoscopic guidance is summarized.

METHODS

In 57 female pigs different techniques for laparoscopic choledocho-jejunostomy have been evaluated. 36 animals underwent a new instrumental anastomosis (TESA = temporary endoluminally-stented Anastomosis) using different size absorbable stents. The results have been compared with 21 animals undergoing laparoscopically handsewn anastomosis. Follow-up and results were identical with minimal differences in final diameter of bile ducts and anastomoses but the operating time was significantly less in the animals operated by TESA-technique.(105 versus 165 min, p < 0.01).

CONCLUSIONS

Applying TESA or handsewn anastomosis, laparoscopic choledochojejunostomy can be performed rapidly and safely revealing good bypass function over a period of three and six months respectively. With regard to treatment for non-resectable peri-ampullary tumors TESA may offer a new therapeutic approach combining the benefits of minimally invasive endoscopic stent placement with the functional results and lower readmission of conventional Roux-en-Y choledochojejunostomy.