Access loop Roux-en-Y Hepaticojejunostomy: revisited - a study of twenty two cases over 15 years (2001-2015)

Authors

  • M. S. Ray Department of Surgery, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab. India
  • B. S. Deepak Department of Surgery, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab. India

DOI:

https://doi.org/10.18203/2349-2902.isj20170856

Keywords:

Access Loop, Biliary strictures, Biliary access, Hepaticojejunostomy, Roux-en-Y

Abstract

Background: Access-loop Roux-en-Y hepaticojejunostomy (HJ), an interesting and an unique surgical technique described in the past seems to have resurfaced amidst commendation and condemnation.

Methods: The technique involves the incorporation of a cutaneous access stoma in the Roux-en-Y loop of jejunum used for the anastomosis. This stoma provides permanent access to the bilio-enteric anastomosis and thus to the hepatobiliary tree for non-operative management of chronic and recurrent biliary tract problems. Here we are presenting our experience in 22 cases managed by us with “access-loop Roux-en-Y hepaticojejunostomy (HJ)” over a period of 15 years (2001 to 2016).

Results: 22 cases were managed successfully. The maximum follow-up was for 05 years with no recurrence or stricture only 01 patient had a small Incisional hernia.

Conclusions: The objective of this work is to, describe an optional technique (although less known and practiced) during the accomplishment of a "roux-en-Y" hepaticojejunostomy that, allows future endoscopic and interventional radiology access to the bilio-enteric anastomosis.

Author Biographies

M. S. Ray, Department of Surgery, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab. India

Dr. M S Ray, MBBS, MS (General Surgery), Long-term training in Gastro-Intestinal Surgery (AIIMS-New Delhi)

B. S. Deepak, Department of Surgery, Military Hospital, Jalandhar Cantt, Jalandhar, Punjab. India

Dr. B S Deepak, MBBS, MS (General Surgery), DNB (General Surgery), MRCS, MNAMS, FMIS, FACS

References

Dolan JP, Diggs BS, Sheppard BC, Hunter JG. Ten-year trend in the national volume of bile duct injuries requiring operative repair. Surg Endosc. 2005;19:967.

Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campbell KA, Talamini MA, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg. 2000;232:430.

Jabłońska B, Lampe P, Olakowski M, Górka Z, Lekstan A, Gruszka T. Hepaticojejunostomy vs. end-to-end biliary reconstructions in the treatment of iatrogenic bile duct injuries. J Gastrointest Surg. 2009;13:1084.

Hintze RE, Adler A, Veltzke W, Rebyeh H. Endoscopic access to the papilla of vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en-Y gastrojejunostomy. Endoscopy. 1997;29:69.

Lopes TL, Wilcox CM. Endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy. Gastroenterol Clin North Am. 2010;39:99.

Pessa ME, Hawkins IF, Vogel SB. The treatment of acute cholangitis: percutaneous transhepatic biliary drainage before definitive therapy. Ann Surg. 1987;4:389-92.

Chen M, Jan Y, Lee T. Percutaneous transhepatic biliary drainage for acute cholangitis. Int Surg. 1987;72:131-3.

Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg. 2005;241:786.

Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery. 2007;142:450.

Ludwig K, Bernhardt J, Lorenz D. Value and consequences of routine intraoperative cholangiography during cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2002;12:154.

Parlak E, Ciçek B, Dişibeyaz S, Cengiz C, Yurdakul M, Akdoan M, et al. Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy. Surg Endosc. 2010;24:466.

Downloads

Published

2017-02-25

Issue

Section

Original Research Articles