Jejunoduodenal anastomosis as permanent biliary access loop post-hepaticojejunostomy: our experience

Authors

  • Moustafa Baiomy Department of General Surgery, Zagazig Faculty of Medicine, Zagazig, Sharkia, Egypt
  • Mohamed Riad Department of General Surgery, Zagazig Faculty of Medicine, Zagazig, Sharkia, Egypt
  • Hassan A. Saad Department of General Surgery, Zagazig Faculty of Medicine, Zagazig, Sharkia, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20194033

Keywords:

Biliary injuries, Laparoscopic cholecystectomy, Hepaticojejunostomy, Access loop, Jejunoduodenal anastomosis

Abstract

Background: Post-hepaticojejunostomy stricture is a common problem may result in liver cirrhosis and portal hypertension and death if not treated. Different modalities to repair it are available including endoscopic management that needs access loop (including jejuno-duodenal access loop) to reach the site of stricture.

Methods: This prospective study was done in general surgery department, faculty of medicine, Zagazig University hospitals during the period from January 2016 to December 2018. The study included 23 patients (18 females and 5 males) all needed hepaticojejunostomy to treat biliary injuries during cholecystectomy, biliary stricture post-cholecystectomy or post-hepaticojejunostomy anastomotic stricture. Their ages ranged between 26 to 57 ys with mean age 37.3±5.1. The postoperative course of patients and the feasibility of postoperative endoscopic access to the hepaticojejunostomy and intrahepatic ductal system were assessed.

Results: This study included 23 patients (18 females and 5 males) where 19 (82.6%) patients were presented post-cholecystectomy and 4 (17.4%) patients post-hepaticojejunostomy, with different modes of presentation postoperative complications included; 2 patients complicated with chest infection, 3 (13%) patients with wound seroma and infection, 2 (about 8.7%) patients complicated with biliary gastritis and 1 (about 4.4%) patient with mild attack of cholangitis. There was no anastomotic leakage or mortality in the studied group. The trial of access to the hepaticojejunostomy using gastroduodenoscopy was successful in all cases with ease including trial of balloon dilatation. The average hospital stay ranged between 5-7 days.

Conclusions: Side-to-side jejunoduodenal anastomosis is a very useful technique as it provides good endoscopic access to hepaticojejunostomy and the intrahepatic ducts and needs more application and further evaluation.

References

Al-Ghnaniem R, Benjamin I. Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury. Br J Surg. 2002;89:1118-24.

Chapman W, Halevy A, Blumgart L, Benjamin IS. Postcholecystectomy bile duct strictures. Management and outcome in 130 patients. Arch Surg. 1995;130:597-602.

Lillemoe K, Melton G, Cameron J, Pitt HA, Campbell KA, Talamini MA, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg. 2000;232:430-41.

Frattaroli F, Reggio D, Guadalaxara A, Illomei G, Pappalardo G. Benign biliary strictures: a review of 21 years of experience. J Am Coll Surg. 1996;183:506-13.

Hutson D, Russell E, Yrizarry J, Levi JU, Livingstone AS, Guerra J, et al. Percutaneous dilatation of biliary strictures through the afferent limb of a modified Roux-en-Y choledochojejunostomy or hepaticojejunostomy. Am J Surg. 1998;175:108-13.

Koornstra J. Double balloon enteroscopy for endoscopic retrograde-cholangiopancreatography after Roux-en-Y construction:case series and review of the literature. Neth J Med. 2008;66:275–9.

Itoi T, Ishii K, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, et al. Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol. 2010;105:93–9.

Moellmann B, Ruhnke M, Kremer B. Cholangio-duodenal interposition of an isolated jejunal segment after central resection. Hepatobiliary Pancreat Dis Int 2004;3:259–264

Prakash K, Ramesh H, Jacob G, Venugopal A, Lekha V, Varma D, et al. Multidisciplinary approach in the long-term management of intrahepatic stones: Indian experience. Indian J Gastroenterol. 2004;23:209–13.

Selvakumar E, Rajendran S, Balachandar T, Kannan DG, Jeswanth S, Ravichandran P, et al. Long-term outcome of gastric access loop in hepaticojejunostomy. Hepatobiliary Pancreat Dis Int. 2008;7:152–5.

Jayasundara J, De Silva W, Pathirana A. Therapeutic value and outcome of gastric access loops created during hepaticojejunostomy for iatrogenic bile duct injuries. Surgeon. 2010;8:325–9.

Ayman A, Hosam A. Post-cholecystectomy bile duct injuries:when to repair? Int Surg J. 2018;5(5):1649-56.

Lau W, Lai E, Lau S. Management of bile duct injury after laparoscopic cholecystectomy:a review. ANZ J Surg. 2010;80(1-2):75-81.

Loinaz C, González E, Jiménez C, García I, Gómez R, González-Pinto I, et al. Long-term biliary complications after liver surgery leading to liver transplantation. Word J Surg. 2001;25(10):1260-3.

de Santibaoes E, Ardiles V, Gadano A. Liver transplantation: the last measure in the treatment of bile duct injuries. World J Surg. 2008;32(8):1714-21.

Waage A, Nilsson M. Iatrogenic bile duct injury:a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg. 2006;141(12):1207-13.

Connor S, Garden J. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006;93(2):158-68.

Windsor JA, Pong J. Laparoscopic biliary injury: more than a learning curve problem. Aust N Z J Surg. 1998;68(3):186-9.

Tocchi A, Costa G, Lepre L. The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. Ann Surg. 1996:224:162–7.

Jabłońska B, Lampe P. Iatrogenic bile duct injuries:etiology, diagnosis and management. World J Gastroenterol. 2009;15:4097–104.

Machado N. Biliary complications post-laparoscopic cholecystectomy: mechanism, preventive measures, and approach to management: a review. Diagn Ther Endosc. 2011;967017.

Csendes A, Navarrete C, Burdiles P, Yarmuch J. Treatment of common bile duct injuries during laparoscopic cholecystectomy:endoscopic and surgical management. World J Surg. 2001;25:1346–51.

Bismuth H, Majno P. Biliary strictures: classification based on the principles of surgical treatment. World J Surg. 2001;25:1241–4.

Yan J, Peng C, Ding J. Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury. World J Gastroenterol. 2007;13:6598–602.

Draganov P. Endoscopic management of biliary stricture after liver transplantation. World J Gastroenterol. 2009;15:3725–33.

Koornstra J. Double balloon enteroscopy for endoscopic retrograde cholangiopancreatography after Roux-en-Y construction:case series and review of the literature. Neth J Med. 2008;66:275–9.

Moellmann B, Ruhnke M, Kremer B. Cholangio-duodenal interposition of an isolated jejunal segment after central resection. Hepatobiliary Pancreat Dis Int. 2004;3:259–64.

Jayasundara J, De Silva W, Pathirana A. Therapeutic value and outcome of gastric access loops created during hepaticojejunostomy for iatrogenic bile duct injuries. Surgeon. 2010;8:325–9.

Abdel Modaber A. and Hammad A. diagnosis and treatment of post-cholecystectomy iatrogenic biliary injury. Austin J Surg. 2017;4(5):1116

Agabiti N, Stafoggia M, Davoli M. Thirty-days complications after laparoscopic or open cholecystectomy: A population-based cohort study in Italy. BMJ Open. 2013;3:19-43.

Ibrahim A, Hany A, Sherif M. Iatrogenic Biliary Injuries: Multidisciplinary Management in a Major Tertiary Referral Center. HPB. 2014;30:30-41.

Cameron J, Gadacz T. Laparoscopic cholecystectomy. Ann Surg. 1991;213:1-2.

Schmidt SC, Settmacher U, Langrehr JM, Neuhaus P. Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery. 2004;135(6):613-8.

Fleming K, Lucey B, Soto J, Oates M. Posttraumatic bile leaks:role of diagnostic imaging and impact on patient outcome. Emerg Radiol. 2005;12(3):103-7.

Waleed S, Mahafza M, Azmi M, Azmi A. Magnetic Resonance Cholangiopancreatography in Post Laparoscopic Cholecystectomy Patients. JMJ. 2005;39(1):23-9.

Ramesh H, Prakash K., Kuruvilla K, Philip M, Jacob G, Venugopal B. Biliary access loops for intrahepatic stones: results of jejunoduodenal anastomosis. ANZ J Surg. 2003;73:306–12.

Fischer C, Fahy B, Aloia T. Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries. HPB. 2009;11:32-7.

Ardiles V, Santibáñes D, Pekolj J. Complex bile duct injuries: management. HPB, 2008;10(1):4-12.

Bittner R. laparoscopic surgery - 15 years after clinical introduction. World J Surg. 2006;30:1190-203.

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Published

2019-08-28

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Original Research Articles