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Roux-en-Y hepaticojejunostomy: a reappraisal of its indications and results
Insights
Hepaticojejunostomy is a safe and effective procedure for bile duct strictures and stones, offering good long-term outcomes with low complication rates. This surgical technique avoids complications like sump syndrome associated with choledochoduodenostomy.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Surgical Outcomes
Background:
- Bile duct reconstruction is crucial for managing strictures and stones.
- Hepaticojejunostomy and choledochoduodenostomy are common surgical options.
- Potential complications include sump syndrome and enteric reflux.
Purpose of the Study:
- To critically evaluate the outcomes of hepaticojejunostomy in 131 patients.
- To compare the efficacy and safety of hepaticojejunostomy with other procedures.
- To assess long-term results and complication rates.
Main Methods:
- Retrospective analysis of 131 patients undergoing choledocho or hepaticojejunostomy.
- Indications included iatrogenic common bile duct (CBD) strictures and choledocholithiasis.
- Follow-up data collected for 80 patients over 2-13 years.
Main Results:
- Overall mortality rate was 4%, primarily due to renal hepatic failure, bile peritonitis, and bleeding.
- Low complication rate: one biliary fistula requiring reoperation.
- Long-term follow-up showed 78.7% symptom-free, with manageable cholangitis in 8 patients and reoperation for stricture in 9.
Conclusions:
- Hepaticojejunostomy demonstrates favorable long-term results and a low complication profile.
- It effectively avoids sump syndrome and enteric reflux into the CBD.
- Roux-en-Y hepaticojejunostomy is a viable option for high strictures and reoperations.
Abstract:
A critical evaluation is made of 131 patients submitted to choledocho or hepaticojejunostomy. The main indications for hepaticojejunostomy were iatrogenic strictures of CBD (60 patients), and choledocholithiasis with markedly dilated duct (41 patients). The overall mortality rate was 4% representing principally renal hepatic failure, bile peritonitis and bleeding. The complications following hepaticojejunostomy included only in one case biliary fistula which required reoperation. The long-term results of 80 patients available for a followup study were as follows: 63 patients (78.7%) were symptom-free at 2-13 years followup; 8 patients had brief episodes of cholangitis which responded to antibiotic and corticosteroid treatment; 9 patients required reoperation for stricture of anastomosis. These overall results are a strong argument for hepaticojejunostomy which, compared with choledochoduodenostomy, avoids the hazards of the so-called sump syndrome and of the reflux of enteric contents in the CBD. An increased incidence of peptic ulcer disease in the patients submitted to hepaticojejunostomy was not observed. In very high strictures and in reinterventions anastomosis between left hepatic duct and Roux-en-Y jejunal limb was carried out. The results achieved with this technique, which was performed in 26 patients, were about the same following hepaticojejunostomy.