The cholangiojejunostomy has undergone more than 130 years of continuous improvement and development. From the initial gallbladder jejunostomy, it has gradually formed cholecystoduodenal anastomosis, biliary duodenal anastomosis, and interposition jejunum biliary duodenum Roux-en-Y bile duct jejunum anastomosis, bile duct jejunal loop anastomosis, Kasai portal jejunal anastomosis, bile duct jejunum T-tube bridging drainage, Oddi sphincterotomy and modified bile duct jejunal loop anastomosis. None of the above-mentioned techniques can solve all problems perfectly.

For example, gallbladder anastomosis, although the gallbladder is more easily exposed during the operation, which reduces the operation time and reduces the difficulty of the operation, the reflux of intestinal contents into the slender cystic duct can easily cause its obstruction and increase the occurrence of reflux cholangitis. As a result, the clinical application of this surgical method is gradually decreasing. Gallbladder-duodenal anastomosis, biliary duodenal anastomosis, and interposition jejunal biliary duodenal anastomosis with duodenum as the side end of the anastomosis, the contents of the duodenum are easier to flow back into the bile duct Cause reflux cholangitis. Even if the bile duct duodenal anastomosis can achieve side-to-side anastomosis at both ends, it will inevitably cause reflux content to accumulate at the end of the bile duct and cause repeated inflammation, so these procedures are almost abandoned in clinical practice. 

Bile duct jejunum T-tube bridging drainage is often a palliative treatment for patients with malignant biliary obstruction who are elderly, poor in physical condition, and unable to withstand long-term surgery. Today, as endoscopic technology is becoming more and more mature, Oddi sphincterotomy has also been replaced by endoscopic treatment. However, the Kasai portojejunostomy is difficult to achieve a simple bile duct tissue and intestinal tissue mucosal and mucosal corresponding anastomosis, which inevitably leads to an increase in the probability of anastomotic stenosis, so it is less clinically used. However, in the surgical treatment of hilar cholangiocarcinoma, Kasai hilarjejunostomy is one of the more commonly used procedures. Although the bile duct-jejunal loop anastomosis ensures the integrity of the intestine, there is still food passing through the bile duct anastomosis, and reflux cholangitis cannot be avoided. 

Some scholars have designed an improved bile duct jejunal loop anastomosis. Because the jejunum between the two anastomoses is ligated with a thread, it theoretically avoids the flow of intestinal contents through the biliary-enteric anastomosis. At the same time, some scholars use this technique as a bile-enteric anastomosis. First choice, and has achieved good clinical results. Roux-en-Y bile duct jejunum anastomosis is currently the most recognized and most used procedure in biliary-enteric anastomosis. This operation can effectively reduce the occurrence of reflux cholangitis by extending the biliary branch and intestine loop. Some scholars have followed up more than 1,000 patients who underwent cholangiojejunostomy. Among the three different cholangiojejunostomy, the incidence of cholangiocarcinoma after Roux-en-Y cholangiojejunostomy is the lowest.

However, there are also reports in the literature that the incidence of vascular complications (hepatic artery thrombosis and portal vein thrombosis) after Roux-en-Y anastomosis of the bile duct jejunum has increased, which also shows that this procedure still has shortcomings. At this stage, there is no biliary-enteric anastomosis that can be perfect, but Roux-en-Y bile duct jejunal anastomosis has been highly recognized and accepted as the mainstream operation in biliary-enteric anastomosis. At the same time, the author believes that if the modified bile duct jejunum loop anastomosis has been verified by a large number of clinical practice, it is also worth recommending.

Disposable Stapler

Disposable Circumcision Stapler

Disposable Anorectal Stapler

Intraluminal Surgical Stapler

Disposable Laparoscopic Linear Cutte