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

Benign biliary strictures are an uncommon but significant complication following hepatobiliary surgeries, most often seen after cholecystectomy or biliary-enteric anastomosis. While Roux-en-Y hepaticojejunostomy is the standard surgical treatment for high bile duct strictures, recurrence of the stricture remains a complex problem, especially when the anatomy is distorted by fibrosis or previous surgery or when it presents as cholangitis episodes very late after surgery. Revision surgery in these cases is challenging, and timely recognition and resource-appropriate interventions are key to optimal outcomes.

We describe a case series of seven patients who underwent revision surgery for recurrent benign biliary strictures following Roux-en-Y hepaticojejunostomy. Three patients were found to have high-level strictures (Strasberg E4) at the time of revision surgery. While most patients were managed with standard surgical techniques, in one of these patients, dense adhesions and scarring made ductal identification nearly impossible, where intraoperative ultrasound-guided biliary catheter placement was used as a salvage technique to localize the biliary ducts transhepatically, creating a neo-hepaticojejunostomy.

All patients had a satisfactory recovery, with resolution of jaundice and normalization of liver function over a follow-up period of one year.

Revision surgery for recurrent benign biliary strictures after Roux-en-Y hepaticojejunostomy remains technically demanding due to altered anatomy and fibrosis, where it becomes difficult to differentiate structures. Careful preoperative planning, meticulous intraoperative dissection, flexible surgical strategies, and multidisciplinary cooperation and planning are essential for successful reconstruction and favorable outcomes.