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Hepaticojejunostomy using a Roux-en-Y jejunal limb via the retrocolic-retrogastric route
Masato Nagino1, Junichi Kamiya, Michio Kanai
1Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466, Japan. nagino@med.nagoya-u.ac.jp
Background:
Hepaticojejunostomy following hepatobiliary resection has been performed using a Roux-en-Y jejunal limb via the antecolic or the retrocolic-anteduodenal route. However, in morbidly obese patients difficulty arises from the thickened, foreshortened mesentery of the jejunum and from limited mobility due to intra-abdominal fat deposition.
Methods:
We developed new placement of Roux-en-Y jejunal limb in which the limb is placed via the retrocolic-retrogastric route. Hepaticojejunostomy via this route was performed in 133 obese and nonobese patients with biliary cancer.
Results:
Tension-free anastomosis was successfully performed in all patients. Neither early nor late complications directly related to this new reconstruction route occurred.
Conclusions:
The retrocolic-retrogastric route is simple and an alternative to the standard methods of biliary reconstruction following hepatobiliary resection. This new placement may circumvent the obesity-related problem.