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Resume Introduction. – Cette etude retrospective de 20 patients reoperes pour dysfonctionnement d'une anastomose biliodigestive comprend sept anastomoses choledocoduodenales (ACD) et 13 anastomoses hepatico- ou choledocojejunales (AHJ). Methodes et resultats. – Les dysfonctionnements ont ete reveles par des acces d'angiocholite (16 cas), un ictere nu (3 cas) et un syndrome abdominal aigu hyperalgique (1 cas). Parmi les sept ACD, le delai moyen de reintervention a ete de 14 ans, la reintervention a ete motivee par une atteinte biliaire dans cinq cas (stenose 1 cas, obstruction anastomotique 4 cas) ou par une stenose duodenale (2 cas). Les ACD ont ete transformees en AHJ. La mortalite operatoire a ete nulle, la morbidite de 14 %. Une recidive d'angiocholite a ete observee a long terme. Pour les 13 AHJ, le delai de reintervention a ete de six ans et neuf mois, la reintervention a ete motivee par une stenose anastomotique (7), un empierrement sans stenose (4) ou des anomalies de l'anse montee (2). L'anse en Y a ete allongee en cas de longueur insuffisante et l'anastomose refaite en cas d'anomalie. Les AHJ laterolaterales ont ete converties en terminolaterales. La mortalite operatoire a ete nulle, la morbidite de 8 %. A long terme, deux recidives de stenose et une recidive de lithiase ont ete observees. Conclusions. – Les dysfonctionnements des anastomoses biliodigestives se traduisent essentiellement par des acces d'angiocholite pouvant aboutir a une cirrhose biliaire secondaire. Le traitement des complications des ACD est simple et efficace, l'evolution apres reprise pour des complications d'une AHJ depend de la pathologie initiale.

This retrospective study of 20 procedures for malfunction of a biliary-enteric anastomosis include 7 choledochoduodenal anastomosis (CD) and 13 choledocho- or hepaticojejunal anastomosis (HJ).The malfunctions were revealed by angiocholitis (N=16) jaundice (N=4) acute abdominal syndrome (N=1). Among the 7 CD, the median waiting period before reoperation has been 14 years, the procedures were justified by a biliary disorder in 5 cases (1stricture, 4 stones or food obstruction) or by a duodenal stricture (2 cases). The CD have been converted into HJ. The operative mortality was null, the morbidity rate was of 14%. A recurrence of angiocholite occurred in the long-term followed-up. About HJ, the waiting time before reoperations was 6 years and 9 months, the procedures were justified by anastomotic anastomosis stricture (7) calculi without stricture (4) Roux-en-Y limb anomalies (2). Two Roux-en-Y limbs have been lengthened. The anastomoses have been redone when necessary. The side-to-side HJ were converted in end-to-side HJ. The operative mortality was null, the morbidity rate of 8%. In the long term followed-up, 2 stenosis recurrence and 1 lithiase recurrence occurred.Malfunctions of biliodigestives anastomosis are revealed by angiocholitis that can lead to secondary biliary cirrhosis. The complications treatment of CD is easy and effective. The complications evolution of HJ depends of initial pathology.

To compare the early repair results in bile duct injuries at laparoscopic cholecystectomy to a later repair and so the early reconstruction by an end-to-end anastomosis to a Roux-en-Y bypass.From 1990 to 2003, twelve patients were treated for bile duct injury, not diagnosed at the time of cholecystectomy and had an early repair within 30 days after the cholecystectomy. They had either a duct to duct anastomosis or a Roux-en-Y bypass at the time of the reconstruction.The level of the injury was Bismuth II (N=7), III (N=1), IV (N=2) and V (N=1) referral to Bismuth classification and one isolated right sectoral duct injury. Four patients had an duct to duct anastomosis and eight an hepaticojejunostomy at a median of 15.3 days after cholecystectomy. With one patient lost to follow up, the overall success rate in this series was 81.8% after reconstruction with a mean 40 months follow up. The reconstruction by an end to end anastomosis was successful in 100% of patients (with a mean 31.2 months follow up) and in 71.4% of patients after a Roux-en-Y biliary reconstruction (with a mean 45 months follow up).Good results may be performed, by an early repair in bile duct injuries at laparoscopic cholecystectomy, either by an duct to duct anastomosis or a Roux-en-Y bypass.