Evaluation of eversion technique for bilioenteric anastomosis in bile duct reconstruction

Document Type : Original Article

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Department of Hepatobiliary and General Surgery, Faculty of medicine, Ain Shams University, Egypt

10.21608/ejsur.2025.347107.1323

Abstract

Background: The bilioenteric anastomosis plays a role in the surgical management of biliary tract disease. A wide variety
of techniques for suturing a portion of the biliary tract to the digestive tract have been described with many advances in
surgical techniques. Preoperative and postoperative care have contributed to the low morbidity of current reconstructive
biliary surgery. The eversion technique has been gaining attention as an alternative to traditional anastomosis methods.
This involves inverting the enteric mucosa and suturing it to the duct wall, thereby creating a stable anastomosis with
reduced tension. While studies suggest that the eversion technique provide advantages such as an improved patency rates and a lower incidence of biliary leaks, evidence comparing its outcomes with other techniques remains limited.
Aim: This study aims to evaluate the eversion technique in bilioenteric anastomosis, focusing on its outcomes, advantages,
and complications. By conducting a comprehensive review and presenting new data, this research aims to contribute to
current discussions regarding the optimal surgical approach for biliary-enteric anastomosis.
Patients and Methods: A prospective cohort study was conducted at Ain Shams University Hospitals and Nasr Institute
Hospitals. Fifty patients underwent bilioenteric anastomosis using the eversion technique in a Roux-en-Y configuration.
Three patients were excluded due to incomplete follow-up. All patients were monitored for complications, including bile
leakage, cholangitis, and strictures.
Results: Out of the 47 patients who completed follow-up, four (8.6%) patients experienced bile leakage. However, all
cases were managed conservatively without requiring reoperation. Three patients developed cholangitis, which was also
managed conservatively. One patient experienced a late stricture and was successfully treated with computed tomographyguided transhepatic balloon dilatation. No incidence of early strictures was observed.
Conclusion: The eversion technique offers significant advantages and promising outcomes in bilioenteric anastomosis,
with a lower incidence of complications.

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