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Enteral nutrition encompasses various methods of delivering nutrition directly to the gastrointestinal (GI) tract, bypassing traditional oral intake. It is particularly beneficial for patients who cannot eat by mouth but have a functioning digestive system. Key methods include nasointestinal feeding, gastrostomy, and jejunostomy, each suited to different clinical scenarios based on the patient's needs and condition.
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Hepaticojejunostomy with gastric access loop versus conventional hepaticojejunostomy: a randomized trial.

Mohamad Raafat1, Morsy M Morsy2, Salah I Mohamed2

  • 1Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt. mohamad_raafat10@yahoo.com.

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|August 9, 2023
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Summary

A modified Roux-en-Y hepaticojejunostomy (RYHJ) with a gastric access loop offers comparable complication rates to the conventional RYHJ. This modification facilitates easier endoscopic management of future hepaticojejunostomy anastomotic strictures.

Keywords:
Gastric access loopHepaticojejunostomy anastomotic strictureRoux-en-Y hepaticojejunostomy

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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.