Treatment Experience of Subsequent Complications after Roux-en-Y Biliojejunostomy

Li, Z.; Cui, Nuan; Chen, L.

doi:10.1159/000216521

Cited by 6 publications

(11 citation statements)

References 19 publications

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“…17 For a long time surgeons relied on RYHJ for BDI reconstruction although it has its drawbacks; the function of the Oddi's sphincter is lost leading to reflux cholangitis, adhesive intestinal obstruction, twisting of jejunal loop, duodenal ulcer, also 7 to 38% of patients develop anastomotic strictures requiring further treatment. 9,18,19 Also as the bile flow path changes fat metabolism impairment happens resulting in loss of weight. 20 Another drawback of RYHJ is that it is not suitable for ERCP required for both diagnosis and treatment of biliary strictures that may develop in the post-operative period because of the limited length of instruments or the small therapeutic channel of the enteroscope.…”

Section: Discussionmentioning

confidence: 99%

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Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Helmy

Ali

2017

Int Surg J

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INTRODUCTIONAbout 80% of BDI occur after cholecystectomy constituting a catastrophe for both the patient and the surgeon as they are associated with significant morbidity and mortality, reducing long-term survival and quality of life, and are associated with high rates of subsequent litigation.1,2 Laparoscopic cholecystectomy (LC) has largely replaced open cholecystectomy (OC) but its potential disadvantage is a 2-fold increase in BDI. Moreover, injuries after LC are more proximal, are revealed earlier, are presented by leaks more than by strictures, are repaired more frequently by nonspecialists, and more associated with lost segment and ischemia due to combined vascular injury.3 Most of BDI present as biliary stricture, external or internal fistula, and biliary peritonitis. 4 If left untreated BDI may be complicated with biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis.5 Also there is ABSTRACT Background: Bile duct injuries (BDI) constitute a disaster for both the patient and the surgeon without satisfactory results with the classic use of roux-en-Y hepaticojejunostomy (RYHJ). The purpose of this study was to evaluate our newly introduced technique utilizing isolated vascularized gastric tube (IVGT) as an alternative for RYHJ in reconstruction of the bile duct after iatrogenic BDI with lost segment. Methods: This is a prospective study included 18 consecutive patients suffered from iatrogenic BDI with lost segment admitted to Assiut and Sohag University Hospitals, during the period from September 2013 to June 2016. Patients were subjected to operative treatment with the interposition of IVGT to bridge the lost bile duct segment. Patients were evaluated regarding demographic criteria, clinical picture, different investigations, efficacy of the use of IVGT and evaluation of post-operative complications after a mean follow-up of 2 years. Results: Eighteen patients underwent repair of BDI utilizing IVGT during the study period. Three patients (17%) suffered immediate repairs, 10 patients (55%) experienced intermediate repairs and late repairs were performed for the last 5 patients (28%). Bile leak as a specific early morbidity was present in 3 patients (17%) with upper biliary tract injury without any operative mortality. Also, there was one patient with stent obstruction relieved by stent extraction. With long-term follow-up there was not any patient of biliary stricture. Conclusions: IVGT proved to be feasible and safe for bile duct replacement and is a good alternative for biliary reconstruction being more anatomical and physiological than RYHJ.

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Section: Discussionmentioning

confidence: 99%

“…29 Additionally it does not have the intestinal complications that may occur after RYHJ and with time there was no tube dilation which leads to bile stasis. 18 Additionally, we were not confronted with cholangitis whether due to anastomotic stricture or due to reflux during the study period, although a longer follow up is needed.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Helmy

Ali

2017

Int Surg J

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“…However, it is not without early and late complications. Reoperation may be necessary because of anastomotic stricture, calculi recurrence, biliary tract infection, or even malignant change [2] . Even though anastomotic stricture is relatively common after a bilioenteric procedure, this patient had not any stricture 10 years after Roux-en-Y choledochojejunostomy.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure has early and late complications although it is effective and sometimes the only alternation [1,2] . The collection of gallstones in the jejunal limb is a rare complication [3] .…”

Section: Introductionmentioning

confidence: 99%

Gallstone in jejunal limb with jejunocolonic fistula 10 years after Roux-en-Y choledochojejunostomy

Suo

Song²,

Tong³

2011

WJR

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Roux-en-Y choledochojejunostomy is a common biliary reconstruction procedure. The collection of gallstones in the jejunal limb is a rare complication. Here we present a case of a 61-year-old Chinese female who received Roux-en-Y choledochojejunostomy 10 years ago. Diagnosis of recurrent bile duct stones accompanying infection was made before operation. She also had an abdominal mass which was possibly an intussuscepted colon or a huge fecolith. At laparotomy, an oval stone (5 cm in diameter) and 3 smaller multifaceted stones (2 cm in diameter) were found in the jejunal limb. A fistula between this jejunum and colon was also found. Although the typical manifestations of diarrhea were present, the diagnosis of a biliary colonic fistula was missed before operation. Partial colectomy was performed with the fistulous opening repaired. A T-tube was left in the jejunal limb and the mesocolon aperture was enlarged and revised. Her postoperative convalescence was uneventful. We report this case hoping to sharpen our diagnostic acumen.

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“…Roux-en-Y hepatico-porto-jejunostomy (RYHJ) is now a well-accepted biliary drainage procedure for benign biliary tract diseases such as choledochal cyst and biliary strictures [1][2][3][4][5]. It involves two anastomoses, namely jejunojejunostomy and hepatico-porto-jejunostomy with a long segment (40 cm) of defunctioning jejunum as the biliary conduit.…”

Section: Introductionmentioning

confidence: 99%

A New Surgical Technique of Biliary Drainage

Hoque¹

2013

IJCM

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Introduction: Roux-en-Y Hepatico-jejunostomy is the standard technique of biliary reconstruction after excision of choledochal cyst. Here the author describes a new surgical technique of biliary reconstruction using native gall bladder as biliary conduit. New Surgical Technique: The choledochal cyst is excised as standard technique but gall bladder with its neck is kept in situ. The gall bladder neck is anastomosed with the common hepatic duct stump and gall bladder fundus is anastomosed with the antero-inferior wall of the first part of distal duodenum. Materials & Methods: Eleven patients with choledochal cyst have been operated with the new technique from July 2011 to December 2012 in the city of Dhaka, Bangladesh. Feeding was started from 3rd post-operative day and drain was removed by 7th day unless complicated and they were released from the hospital between 10 -15 days. Results: The ages of eleven patients were from 3 months to 11 years. There were 7 females and 4 males. Lump was felt in 3 patients and jaundice was present in 4 patients. Recurrent abdominal pain was present in all patients. They were diagnosed by ultrasonography and MRCP was done in 6 patients only. Prothrombin time was elevated by 10% & 15% in 2 patients. Average operation time was 2 hours and 10 minutes. A 9-year girl died suddenly and unexpectedly on the 5th post-operative day from severe convulsion of unknown origin. One child suffered from prolonged bile leakage and re-explored to repair anastomotic leak. Another patient had a collection near the anastomosis which resolved spontaneously. Discussion: Benefits of the new surgical technique are total absence of Roux-en-Y related intestinal complications. Possible disadvantages are discussed. It is anatomical and physiological. Small incision and less operation time are other benefits which need to be mentioned. Possible disadvantages are discussed.

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Treatment Experience of Subsequent Complications after Roux-en-Y Biliojejunostomy

Cited by 6 publications

References 19 publications

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Gallstone in jejunal limb with jejunocolonic fistula 10 years after Roux-en-Y choledochojejunostomy

A New Surgical Technique of Biliary Drainage

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