Cholecystojejunostomy in Dogs

Cholecystojejunostomy is used to treat select cases of bile duct obstruction, formally known as cholestasis. This occurs when bile cannot pass from the liver to the gallbladder and on to the intestines. Cholestasis can cause problems with digestion. The condition can be attributed to a wide range of causes, including trauma, the presence of gallstones (cholelithiasis), cancer, parasitic infection, pancreatitis, and complications from other abdominal surgeries. Cholestasis is more common in older dogs and certain breeds, notably the Miniature Schnauzer and the Shetland sheepdog.

There are two techniques for performing cholecystojejunostomy. However, a technique referred to as loop cholecystojejunostomy is the simplest and most effective, so the procedure steps for only this technique will be discussed.

1. The dog will first be stabilized via supportive therapy and the administration antibiotics.
2. The dog will then be anesthetized.
3. The surgeon will make an initial incision into the left side of the abdomen and isolate the gallbladder and jejunum with special sponges.
4. Before operating, the surgeon will ensure the cystic duct and the proximal portion of the bile duct are not obstructed.
5. The surgeon will make an incision into the gallbladder before creating a jejunal loop and making an incision that is the same size as the one in the gallbladder.
6. If any omental adhesions are present, the surgeon will remove the gallbladder and jejunal loop from the adhesions before suturing.
7. The surgeon will then begin suturing, using full-thickness bites to connect the gallbladder and jejunum, ensuring the mucosa of both organs are in constant contact using forceps.
8. A drain is left in position after surgery is completed to drain blood and bile leakage that occurred during surgery.

The efficacy of cholecystojejunostomy will vary based on the underlying cause of the bile duct obstruction. Most dogs that undergo cholecystojejunostomy procedures and do not present postoperative complications will usually make a full recovery. The most common complication associated with cholecystojejunostomy is cholangitis, or bacterial infection of the bile duct. This is usually treated with antibiotics.

Dogs are usually hospitalized following surgery while excess blood and bile leakage is resolved. Dogs will receive supportive care, including intravenous fluid and nutritional therapy as well as pain management medications. Dietary changes are almost always recommended by veterinarians in cases of gallbladder or bile duct conditions treated with surgery.

On the return home, owners should ensure their dog gets plenty of rest and does not engage in activity. Owners should not allow their dog to irritate the surgery site. If swelling, drainage, or bleeding occurs, owners should contact their trusted veterinary professional immediately.

The cost of cholecystojejunostomy may vary depending on any additional procedures required as well as supportive care administered during hospitalization. Treatment for bile duct obstruction can range from $1,500 to $6,000. The average cost of treating bile duct obstruction is $3,000.

Bleeding or bile leakage can occur in the first 24 hours following surgery. If this happens, the surgeon will need to perform an additional exploratory surgery to identify the cause. Cholangitis is the most common complication of surgery and is usually treated with a course of antibiotics. Many dogs experience weight loss. This is because cholecystojejunostomy can cause the digestive system to improperly digest lipids. However, using the proximal part of the jejunum for the anastomosis – connection of parts of the intestine – can minimize the risk of weight loss and the maldigestion of lipids.

It is difficult to prevent cases of bile duct obstruction that are associated with inflammatory conditions such as pancreatitis. Owners should monitor their dogs to ensure they do not consume foreign bodies that can cause bile duct obstruction or engage in activities that can cause bile duct trauma.