Management of Anastomotic Strictures Following Roux-en-Y Hepaticojejunostomy: Our Experience

Area of Science:

• Hepatobiliary Surgery
• Surgical Gastroenterology

Background:

• Benign biliary strictures are a significant complication after hepatobiliary surgeries, particularly Roux-en-Y hepaticojejunostomy.
• Recurrent strictures pose complex challenges due to distorted anatomy, fibrosis, and potential late cholangitis.

Purpose of the Study:

• To describe the outcomes of revision surgery for recurrent benign biliary strictures following Roux-en-Y hepaticojejunostomy.
• To highlight the technical difficulties and successful management strategies in complex cases.

Main Methods:

• A case series of seven patients undergoing revision surgery for recurrent benign biliary strictures was reviewed.
• Standard surgical techniques were employed, with intraoperative ultrasound-guided biliary catheter placement used as a salvage technique in one complex case with dense adhesions.

Main Results:

• All seven patients experienced satisfactory recovery, with resolution of jaundice and normalization of liver function within one year.
• The salvage technique using intraoperative ultrasound successfully localized biliary ducts in a challenging case.

Conclusions:

• Revision surgery for recurrent benign biliary strictures is technically demanding due to altered anatomy and fibrosis.
• Successful outcomes depend on meticulous preoperative planning, flexible intraoperative strategies, and multidisciplinary collaboration.