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Choledochoduodenostomy is a surgical procedure performed to create a passage from the bile duct directly to the intestine to allow bile to flow freely and digest fats in the intestine. This may be necessary if the gallbladder is not present or not functioning as a storage organ or if the bile duct becomes chronically blocked due to medical conditions preventing the natural flow of bile. Stents made with artificial materials that may be used to open the bile duct after blockage has occurred, often pass through the gastrointestinal system due to peristaltic contraction and lack a vascular supply, making them unsuccessful. A choledochoduodenostomy using enlarged bile duct tissue and wire struts/rings mitigates some of these issues. A choledochoduodenostomy requires that the bile duct is of sufficient diameter to insert a wire strut or ring and reroute the duct to the duodenum. Because this duct is relatively small in most dogs it is not commonly performed on them. The procedure is possible if the duct has become enlarged due to blockage or if a primary surgery to ligate the duct and cause enlargement is performed first. A veterinarian surgeon with the expertise to perform this procedure and a dog that is a good candidate for the procedure due to a sufficiently sized bile duct is required for this procedure to be successful.
This procedure may be recommended to address a condition discovered during exploratory surgery or with radiographs your veterinarian may perform to determine the cause of gastrointestinal distress. Due to the risk of infection from gallbladder and bile duct surgery, prophylactic antibiotics may be recommended prior to surgery.
The diameter of the bile duct must be 1 cm with the ability to create a stoma (incised opening) of up to 2cm in order to perform this procedure. Sometimes a blocked duct has expanded due to blockage. If this has not sufficiently occurred, a primary surgery to ligate the duct and cause it to dilate may be performed 2-3 weeks prior to a secondary surgery to perform anastomosis of the bile duct t the duodenum.
The procedure is performed under general anaesthetic and will require that your dog fast prior to surgery. On the day of surgery, your dog will be examined by your veterinarian to ensure they are able to undergo surgery. Your dog will be put under general anesthetic which will include intravenous anesthesia and intubation for gaseous anesthetic. Your dog will be administered intravenous fluids during and post-operatively and vital signs will be closely monitored throughout the procedure. Once under anesthesia, your dog's abdomen will be shaved and cleaned and an incision made to expose the bile duct and duodenum. This procedure may be done in conjunction with removal of the gallbladder if so, this will be performed prior to anastomosis of the bile duct to the duodenum. Incisions will be made in the bile duct and duodenum and an anastomosis, surgical connection, created to connect them. A stainless steel strut or rings will be used to structurally support the rerouted bile duct. Incisions will be carefully closed and observed for signs of anastomotic leakage or hemorrhaging prior to final closure of the abdominal incision. Post operatively your dog will be observed for 24-48 hours and administered pain killers, antibiotics and intravenous fluids during this time.
Choledochoduodenostomy may be recommended because artificial materials used to repair damaged bile ducts often either passed through the gastrointestinal system with peristaltic contractions, or become blocked with materials, and do not possess a blood supply. A choledochoduodenostomy mitigates these issue as it uses bile duct tissue rerouted to the duodenum. However, due to the size of the bile duct, this surgery may not be feasible or may be very difficult to perform in your dog. Also because the conditions necessitating this surgery usually cause severe illness in your dog, the effectiveness of this procedure will depend on the extent of illness and damage to gastrointestinal structures that has occurred.
Your dog will require that activity be restricted for at least two weeks post-surgery; cage rest may be recommended for a few days after surgery and an Elizabethan collar to prevent your dog from licking or chewing their abdominal incision will be necessary. Care for medical conditions present that precipitated this surgery such as pancreatitis may also be required. You should monitor your dog's surgical wound for signs of infection which may include redness, soreness or infected discharge. Your dog's condition should be carefully observed and signs including lethargy, behavioral changes or lack of appetite should be addressed with your veterinarian. Follow-up with your veterinarian will probably be recommended. Your dog will require a special diet that is low in fat post-surgery, and possibly on an ongoing basis, so as not to stress the biliary system.
Because severe illness may be present in your dog prior to this procedure, treatment and postoperative care may be extensive depending on their recovery needs. Choledochoduodenostomy can cost between $1,000 and $2,000 for the routine procedure and may incur further costs depending on your dog's requirements.
Risks associated with a choledochoduodenostomy procedure for your dog include the risk of aspiration during anesthesia, hemorrhaging due to high vascularization, and infection from peritonitis due to leakage of the anastomosis, surgical connection of the bile ducts to the duodenum. Close monitoring of your dog's vital signs and anesthesia, and an experienced surgical team will mitigate these risks. Your dog's condition and prognosis should be discussed with your veterinarian prior to the procedure.
Obesity in your dog due to a high fat diet and lack of exercise will contribute to the chances of your dog developing bile duct blockages. A balanced diet and exercise will mitigate the risk of your dog requiring surgery to their biliary system. Ensure your dog gets regular veterinary check ups and that any symptoms of illness or disease are addressed with your veterinarian as soon as possible. Gallbladder symptoms that are addressed at an early stage may be treated with diet changes or medications that would avoid the necessity for surgical intervention.
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