Modified "Roux en Y" hepaticojejunostomy to permit transgastric endoscopic access

Moricz, André de; Azevedo, O.; Campos, Tércio De; Colaiácovo, Rogério; Akiba, Tadayoshi; Silva, Rodrigo Altenfelder; Pacheco, Adhemar Monteiro

doi:10.1590/s0102-86502014001700003

Cited by 2 publications

(2 citation statements)

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“…Endoscopic ultrasound with the creation of a hepaticogastrostomy has also been used for biliary anastomotic strictures post-RYBD as an alternative to a major relaparotomy [16]. A modification of the 'access' loop with the end of the Roux loop anastomosed to the anterior wall of the stomach has also been attempted [2]. This allowed endoscopic access to the bilio-enteric anastomosis in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the enormous surgical advancements in the last century, access to the biliary system is lost when a Rouxen-Y biliary drainage (RYBD) procedure is performed. Attempts have been made to overcome this inconvenient sequel by using alternative techniques that have not been universally accepted for many reasons [1][2][3][4][5]. Although access to the biliary tree post-RYBD is possible with interventional radiology, this highly specialized service is rarely available, especially in developing countries [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Isolated vascularized gastric tube biliary enteric drainage: a paediatric case series experience

et al. 2021

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Background Despite the enormous surgical advancements in the last century, access to the biliary system is lost when a Roux-en-Y (RY) biliary drainage procedure is performed. Attempts have been made to overcome this inconvenient sequel using variations in the RY anastomosis, small bowel grafts and vascular grafts. These have been predominantly unsuccessful. An isolated vascularized gastric tube (IVGT) graft has been reported in the literature, which was successfully used for adult patients with common bile duct injuries. We have adopted the technique of using an IVGT graft for bile duct reconstruction in the paediatric patients at our institution. We reviewed our experience at our institution between January 2015 and October 2019. This was a retrospective review of all paediatric patients undergoing an IVGT graft procedure for biliary tract anatomical obstruction in the past 5 years. We looked at the indications for surgery, the demographic profile of the patients and outcomes following surgery and outlined the surgical technique used. Results IVGT bile duct reconstruction was performed on eight patients. Patients ranged from 2 months to 7 years, and there was an equal number of males and females. The diagnosis was made on clinical suspicion and confirmed with ultrasound (U/S) and magnetic resonance cholangiopancreatography (MRCP). There was an 87.5% resolution of biliary obstruction, and two patients who had bile leaks postoperatively were managed conservatively. Unfortunately, one patient died in the early postoperative period from sepsis due to pneumonia. Follow-up was for a minimum of 6 months and up to 5 years. Conclusion IVGT biliary enteric drainage is a safe, reproducible procedure that allows access to the biliary tree if required in the future. Thus, this procedure serves as an alternative, especially in limited-resource areas where interventional radiology is not available for future interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Isolated vascularized gastric tube biliary enteric drainage: a paediatric case series experience

et al. 2021

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Hepaticojejunostomy with gastric access loop versus conventional hepaticojejunostomy: a randomized trial

et al. 2023

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Roux-en-Y hepaticojejunostomy (RYHJ) with the provision of “gastric access loop” was developed to shorten the distance traveled by the endoscope to reach hepaticojejunostomy (HJ) anastomotic site. The aim of our study was to assess modified RYHJ with gastric access loop (RYHJ-GA) and compare it with conventional RYHJ (RYHJ-C) regarding short- and long-term outcomes and, moreover, to evaluate the feasibility and results of future endoscopic access of the modified bilio-enteric anastomosis. Patients eligible for RYHJ between September 2017 and December 2019 were allocated randomly to receive either RYHJ-C or RYHJ-GA. Fifty-two patients were randomly assigned to RYHJ-C (n = 26) or RYHJ-GA (n = 26). Three cases in RYHJ-C and 4 cases in RYHJ- GA developed HJ anastomotic stricture (HJAS) (P=0.68). 3 cases of RYHJ-GA had successful endoscopic dilation and balloon sweeping of biliary mud (one case) or stones (2 cases). Revisional surgery was needed in 2 cases of RYHJ-C and 1 case in RYHJ-GA (P=0.68). Modified RYHJ with gastric access loop is comparable to the classic hepaticojejunostomy regarding complications. However, gastric access enables easy endoscopic access for the management of future HJAS. This modification should be considered in patients with a high risk of HJAS during long-term follow-up.The trial registration number (TRN) and date of registration:ClinicalTrials.gov (NCT03252379), August 17, 2017.

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Modified "Roux en Y" hepaticojejunostomy to permit transgastric endoscopic access

Cited by 2 publications

References 12 publications

Isolated vascularized gastric tube biliary enteric drainage: a paediatric case series experience

Isolated vascularized gastric tube biliary enteric drainage: a paediatric case series experience

Hepaticojejunostomy with gastric access loop versus conventional hepaticojejunostomy: a randomized trial

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