ON VARIOUS occasions it becomes necessary to perform anastomoses between the intestinal tract and the gallbladder, common duct, cysts of the common duct, pancreatic cysts and pancreatic fistulas. Direct anastomosis to the side of the duodenum or jejunum represents a simple type of procedure to allow discharge of the bile or pancreatic secretion into the intestine. Such a direct anastomosis would naturally allow reflux of food and intestinal content, at least to a mild degree, into the structure anastomosed with the intestine. It would appear that this reflux of food and irritating intestinal content might give rise to infection. In the majority of instances this does not occur, at least not to a detrimental degree, particularly when an operation such as cholecystoduodenostomy is performed as a palliative procedure for inoperable carcinoma of the head of the pancreas.
To minimize the danger of infection, an anastomosis between the gallbladder and the