Hepaticojejunostomy with gastric access loop versus conventional hepaticojejunostomy: a randomized trial

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Surgical Techniques
• Biliary Tract Surgery

Background:

• Roux-en-Y hepaticojejunostomy (RYHJ) is a common surgical procedure for biliary reconstruction.
• Accessing the hepaticojejunostomy (HJ) anastomotic site for endoscopic interventions can be challenging due to its length.
• Hepaticojejunostomy anastomotic stricture (HJAS) is a potential long-term complication requiring endoscopic management.

Purpose of the Study:

• To assess the safety and efficacy of a modified RYHJ with a gastric access loop (RYHJ-GA).
• To compare RYHJ-GA with conventional RYHJ (RYHJ-C) regarding short- and long-term outcomes.
• To evaluate the feasibility of future endoscopic access through the modified bilio-enteric anastomosis.

Main Methods:

• A randomized controlled trial comparing RYHJ-GA and RYHJ-C.
• Fifty-two eligible patients were randomly assigned to either RYHJ-GA (n=26) or RYHJ-C (n=26).
• Outcomes assessed included anastomotic strictures, need for revisional surgery, and feasibility of endoscopic access.

Main Results:

• No significant difference in the incidence of HJ anastomotic stricture (HJAS) between RYHJ-C (3/26) and RYHJ-GA (4/26) (P=0.68).
• Revisional surgery was required in 2 cases of RYHJ-C and 1 case of RYHJ-GA (P=0.68).
• RYHJ-GA allowed successful endoscopic management (dilation, stone removal) in 3 cases of HJAS.

Conclusions:

• Modified RYHJ with a gastric access loop is comparable to conventional RYHJ in terms of complications.
• The gastric access loop provides a significant advantage for future endoscopic interventions, particularly for managing HJAS.
• RYHJ-GA should be considered for patients at high risk of developing HJAS during long-term follow-up.