Background : Roux-en-Y choledochojejunostomy (RYCJ) is one of the representative methods for bile duct reconstruction. The main indications for choledochojejunostomy include iatrogenic strictures of the common bile duct (CBD), choledocholithiasis with a dilated duct, and biliary tract cancer. There is often concern about stricture or leakage due to incomplete suturing. We present two cases where we implemented a novel technique.

Methods : During anastomosis, we 1) inserted a silicone tube into the CBD, 2) advanced it into the jejunum, 3) performed a Purse-String suture to complete the anastomosis naming "binding choledochojejunostomy". The initial case involved a 55-year-old male patient who, following laparoscopic cholecystectomy for acute cholecystitis, exhibited complete transection of the CBD. In the second case, a 58-year-old female patient with pancreatic head cancer was scheduled for pancreaticoduodenectomy) but the CBD was found to be minimally dilated. In both cases, the CBD exhibited extreme fragility and thinness. Therefore, we performed binding choledochojejunostomy.

Results : In both cases, no complications immediately after surgery. However, after about two years, both patients developed CBD stones and required interventions. The cause remains unknown, but it is believed to be related to a foreign body reaction caused by the stent inserted during anastomosis. Given the likelihood of requiring future intervention, considering the placement of a T-tube may be a viable approach.

Conclusions : Binding choledochojejunostomy is a feasible method when dealing with a small CBD size. Its significant advantage is its technical simplicity, but it is important to note that there is a higher likelihood of stricture development in the future.