Hepaticojejunostomy Using Short-Limb Roux-en-Y Reconstruction

Felder, Seth; Menon, Vijay G.; Nissen, Nicholas N.; Margulies, Daniel R.; Lo, Simon K.; Colquhoun, Steven D.

doi:10.1001/jamasurg.2013.601

Cited by 38 publications

(33 citation statements)

References 23 publications

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“…However, endoscopic intervention after RY biliary enteric anastomosis is feasible and achieves good results in the hands of experienced endoscopists . It appears that endoscopic intervention can be facilitated surgically by construction of a short limb when fashioning a RY anastomosis without significant increased risks of cholangitis . The potential benefit of using a technique with a higher complication rate because the complications may be easier to manage depends on the relative difference in the incidence of the complication.…”

Section: Discussionmentioning

confidence: 99%

Biliary complications in pediatric liver transplantation: Incidence and management over a decade

Laurence

Sapisochín

DeAngelis³

et al. 2015

Liver Transpl

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This study analyzed how features of a liver graft and the technique of biliary reconstruction interact to affect biliary complications in pediatric liver transplantation. A retrospective analysis was performed of data collected from 2001 to 2011 in a single high-volume North American pediatric transplant center. The study cohort comprised 173 pediatric recipients, 75 living donor (LD) and 98 deceased donor (DD) recipients. The median follow-up was 70 months. Twenty-nine (16.7%) patients suffered a biliary complication. The majority of leaks (9/12, 75.0%) and the majority of strictures (18/22, 81.8%) were anastomotic. There was no difference in the rate of biliary complications associated with DD (18.4%) and LD (14.7%) grafts (P 5 0.55). Roux-en-Y (RY) reconstruction was associated with a significantly lower rate of biliary complications compared to duct-to-duct reconstruction (13.3% versus 28.2%, respectively; P 5 0.048). RY anastomosis was the only significant factor protecting from biliary complications in our population (hazard ratio, 0.30; 95% confidence interval, 0.1-0.85). The leaks were managed primarily by relaparotomy (10/12, 83.3%), and the majority of strictures were managed by percutaneous biliary intervention (14/22, 63.6%). Patients suffering biliary complications had inferior graft survival (P 5 0.04) at 1, 5, and 10 years compared to patients without biliary complications. Our analysis demonstrates a lower incidence of biliary complications with RY biliary reconstruction, and patients with biliary complications have decreased graft survival. Liver Transpl 21:1082-1090, 2015. V C 2015 AASLD.Received January 12, 2015; accepted April 28, 2015.Liver transplantation (LT) in the pediatric population is a successful means of treating end-stage liver disease, producing excellent long-term outcomes. 1 Bile leaks and anastomotic strictures are the most frequently seen early technical postoperative complications, 2,3 with single-center analyses reporting the rate of biliary complications to range from 10% to 45%. [4][5][6][7][8][9][10][11][12] Registry data from pediatric-focused LT programs in North America report an overall rate of biliary complications of approximately 15%. 2,13 Although

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Section: Discussionmentioning

confidence: 99%

Biliary complications in pediatric liver transplantation: Incidence and management over a decade

Laurence

Sapisochín

DeAngelis³

et al. 2015

Liver Transpl

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“…As for patients with PLA related to cholangitis caused by bile duct anastomotic strictures or biliodigestive anastomotic strictures, percutaneous balloon dilatation, and endoscopic stenting have been suggested as a first step for the treatment of those benign stricture. 13,38,[128][129][130] Traditionally, surgery is indicated in biliary complications after hepaticojejunostomy because gaining access to the bilioenteric anastomosis with a conventional duodenoscope is generally impossible. 13 Now, deep enteroscopy techniques (double-balloon enteroscopy, singleballoon enteroscopy, and spiral overtube-assisted enteroscopy) enable access to the anastomosis and subsequent endoscopic management of biliary strictures in patients with hepaticojejunostomy, thus obviating the need for more invasive interventions.…”

Section: Treatment Treatment For Pla Related To Biliary Diseases Not mentioning

confidence: 99%

“…13 Now, deep enteroscopy techniques (double-balloon enteroscopy, singleballoon enteroscopy, and spiral overtube-assisted enteroscopy) enable access to the anastomosis and subsequent endoscopic management of biliary strictures in patients with hepaticojejunostomy, thus obviating the need for more invasive interventions. 13,[128][129][130] In addition, mortality in OLT recipients with PLA is higher than in patients who have not undergone transplantation. [28][29][30] Treatments of PLA after OLT including prolonged antibiotic therapy, drainage, and even retransplantation may be required to improve the outcome.…”

Section: Treatment Treatment For Pla Related To Biliary Diseases Not mentioning

confidence: 99%

Pyogenic Liver Abscess of Biliary Origin: The Existing Problems and Their Strategies

2018

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Pyogenic liver abscess (PLA) of biliary origin in Southeast Asia mainly occurs in patients with intrahepatic bile duct stone (IBDS) and extrahepatic bile duct stone (EBDS), bilioenteric anastomosis, or biliary stent. IBDS, as an endemic to Southeast Asia, remains a frequent etiology of acute cholangitis and PLA. PLA related to IBDS is characterized by high incidences of PLA recurrence and death related to infection, and difficulties in diagnosis of concomitant cholangicarcinoma. PLA of biliary origin is more likely caused by more often presented as polymicrobial infections, and more associated with extended-spectrum β-lactamase (ESBL)-producing isolates. In this review, the authors summarize the differences on the presumed causes, pathogens, multidrug resistance, treatment, and prognosis of PLA between biliary origin and cryptogenic origin, the latter serving as a first and foremost presumed etiology of PLA. The authors also discuss the existing problems on early diagnosis of concomitant cholangicarcinoma related to IBDS.

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“…This approach, which may facilitate both multiple stent placement [7,9] and use of lithotripsy, however, currently only provides success rates of 70 % cases using single-balloon enteroscope [7]. Even though endoscopy may be facilitated with the use of short-limb Roux-en-Y [44] reconstruction or positioning of the Roux-en-Y loop on the duodenum, it should be restricted to experienced centers in the setting of therapeutic evaluation. The percutaneous transjejunal approach represents a valuable alternative to the endoscopic approach with satisfactory long-term results but is also restricted to very few experienced centers [12,13].…”

Section: Conservative Management Choice Of the Approachmentioning

confidence: 99%