OBJECTIVETo investigate the prevention of hepatolithiasis and biliary stricture post choledochojejunostomy using choledochoscopy technique and evaluate feasibility and efficacy of choledochojejunostomy and artificial valve of efferent loop in preventing reflux.

METHODSTo analyze the data of 47 patients with hepatolithiasis who had been operated with Roux-en-Y cholangiojejunostomy and artificial valve of efferent loop to prevent bilio-intestinal regurgitation. Of the patients, 19 were marked with silver nip at the jejunum export of bilio-intestinal anastomosis. The regurgitation, recurrence, anastomotic stricture and their managements after the surgery were investigated.

RESULTSThe bilio-intestinal regurgitation were found in 32 cases (32/47, 68.1%), it suggested that artificial valve could not prevent bilio-intestinal regurgitation efficiently. Two cases of hepatolithiasis recurred and were cured by sinus tract placement with the aid of silver nip mark under choledochoscope instead of re-operation. Of the 6 cases with anastomotic stricture, 5 cases were treated successfully with stone extraction, biliary stent dilatation under the percutaneous transhepatic cholangioscopy (PTCS) and the other one case died.

CONCLUSIONSSilver nip mark provides safe and simple path for the cholangioscopy, it made the treatment of the recurrent biliary stricture and stone safe and brief, made the cholangioscopy play more important role in the hepatolithiasis, residual stone and biliary stricture. PTCS is mini-invasive, safe, simple and effective.