Long-term results of Roux-en-Y hepaticojejunostomy and hepaticojejunoduodenostomy

The results of the long-term follow-up of 202 patients with Roux-en-Y hepaticojejunostomy (Roux-en-Y HJ) and 19 with hepaticojejunoduodenostomy (HJD) are reported. The mortality, morbidity, and the incidence of postoperative anastomotic stenosis were comparable in both groups. One hundred forty patients with Roux-en-Y HJ and 19 with HJD were followed with barium meal and endoscopy. An incidence of 5% postoperative duodenal ulcer was noted in the first group, while no ulcer was seen in the patients with HJD. Preoperative and postoperative gastric acid secretion (basal acid secretion and maximal acid secretion) and serum gastrin levels (basal and after protein meal) were measured in 25 cases with Roux-en-Y HJ and 19 with HJD. The serum gastrin levels were similar initially and remained unchanged after surgery in both groups. However, the mean levels of basal and maximal acid output, which was similar before surgery in both groups, increased significantly only in patients who had Roux-en-Y HJ (p less than 0.001). In conclusion, HJD should be adopted as the preferred type of anastomosis in patients with benign pathology and long-life expectancy.