Cholecystojejunostomy in Cats

Cholecystojejunostomy in cats is a surgical procedure in which the jejunum is positioned next to the gallbladder to divert the flow of bile. Cholecystojejunostomy is a similar surgical procedure to cholecystoduodenostomy, but does not usually require the gallbladder to be mobilized. A veterinary surgeon can use two techniques to perform a cholecystojejunostomy in cats; loop cholecystojejunostomy or Roux-en-Y loop. The goal of using ether technique is to discontinue the use of the deficient bile duct by bringing a segment of the jejunum to the gallbladder for side-by-side anastomosis.  

The veterinarian will create an opening in the two organs and permanently conjoin them, allowing bile to flow directly into the intestine. Bile is the fluid the body uses to break down fats that the feline consumes during a meal. Usually, bile flows down from the liver, into the gallbladder and into the small intestine through a bile duct. However, an obstruction of the bile duct will prevent bile from reaching the small intestine. A veterinary surgeon may perform a cholecystojejunostomy in a cat if he/she has a tumor, trauma, or other condition affecting the flow of bile. 

Prior to surgery, all obstructions are confirmed and biopsies are performed. A veterinary surgeon can use two techniques to perform a cholecystojejunostomy in cats; loop cholecystojejunostomy or Roux-en-Y loop.

Loop Cholecystojejunostomy

1. A proximal section of the jejunum will be brought adjacent to the gallbladder.
2. Two incisions, about 3 cm in length, will be made parallel to each other on the aspects of the jejunum and the gallbladder. 
3. 4/0 synthetic, absorbable suture is used to close the cranial dorsal incision line on the lumen. 
4. The same suture material will be used to close the caudal ventral incision, which will bring the two openings onto one another and allow direct infusion of bile. 
5. Both ends of the suture pattern will be securely knotted to prevent leakage of digestive fluids into the abdominal space. 

Roux-en-Y loop Cholecystojejunostomy

1. A proximal section of the jejunum will be brought adjacent to the gallbladder. 
2. The jejunum is transected and sutured closed.
3. Just caudal to the duodenum, the jejunum is anastomosed to the gallbladder.  

The goal the veterinarian wishes to obtain from a cholecystojejunostomy procedure is to allow the feline to receive bile fluids into the intestine despite the fact that the bile duct is non-functional. If the surgery is successful, bile fluids will be allowed to flow directly from the liver to the gallbladder, directly to the large intestine. The bile will be released in response to the ingestion of a meal as usual and the yellow chemical-filled fluid will restore the cat’s ability to break down fats. 

Following a cholecystojejunostomy surgery, your cat will require a great deal of at-home care. Pain and antibacterial medications will need to be administered every day to ensure a positive recovery. Your veterinarian will recommend a change in diet for a selective period of time and limit the cat’s physical activities.

A feline cholecystojejunostomy procedure will cost a pet owner $3,000 to $6,000. Antibiotics will add another $10-$30 to your total cost and if biopsies are required, an additional $160 or more. 

Felines that require a cholecystojejunostomy procedure are usually very ill, which puts them at a high risk for post-surgical death. In general, felines have a 50/50 chance of survival after surgery. However, if the feline has survived 2-3 days after the surgery, then the likelihood that the cat will live a long life increase greatly. Other considerations of cholecystojejunostomy surgery include jaundice, pancreatitis, and liver infection. 

A cholecystojejunostomy procedure cannot always be prevented, but obesity has been known to be a big factor for bile duct complications in cats. Proper diet and daily exercise are great preventative measures for maintaining a healthy bile duct system.