Translaparoscopic jejunal approach for benign stricture of Roux-en-Y hepaticojejunostomy

Abstract

Although the Roux-en-Y hepaticojejunostomy is the most common surgical procedure for the treatment of bile duct strictures, providing durable long-term results in most patients, when a stricture is present, the management is more difficult, and a reoperation generally will be proposed. However, balloon dilation and endoscopic stenting using the percutaneous transhepatic or transjejunal approach under fluoroscopic guidance have been suggested as the first step or even as definitive management in treating these patients. We present a case report of a patient with a benign biliary stricture as a consequence of a Roux-en-Y hepaticojejunostomy, who was managed through a translaparoscopic jejunal approach because of an unfixed Roux-en-Y loop. In conclusion, we recommend this strategy as the first step for managing the restricture of Roux-en-Y hepaticojejunostomy in patients with an unfixed Roux-en-Y loop.

Choledochoscopic high-frequency needle-knife electrotomy for treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy

“…In this situation, the initial approach for benign stricture of the anastomosis after hepaticojejunostomy has often been to use promising, minimally invasive procedures, such as the endoscopic and percutaneous approaches. As a first step, or even as definitive management in treating these patients, an ultrasonic or fluoroscopic guided percutaneous transhepatic cholangiography (PTC) procedure is performed, followed by choledochoscopic lithotomy, balloon dilatation, and long-term internal/external drainage [ 10 ]. Full-covered self-expanding removable metal stents may be used for persistent strictures after transhepatic intubation [ 11 ].…”