Surgical outcomes of laparoscopic choledochal cyst. Rouxeny hepaticojejunostomy or choledochojejunostomy. Conclusions choledochoscopic highfrequency needleknife electrotomy is both feasible and safe in the treatment of anastomotic stricture after roux en y hepaticojejunostomy, with a similar long. The results of the longterm followup of 202 patients with rouxeny hepaticojejunostomy roux en y hj and 19 with hepaticojejunoduodenostomy hjd are reported. It is a common operation, not only to bypass extrahepatic biliary obstructions, but also to establish biliaryenteric continuity after resections for benign and malignant diseases.
The rouxeny jejunal limb was transected at 3035 cmfrom the ligament oftreitz, wherethe mesentery is ofsufficient length to permit its being delivered into the hilar region of the liver. A distal jejunal loop of approximately 10,0 to 15,0 cm must be kept far from the anastomosis that allows its setting, without tension, in the anterior gastric wall bellow the small bending, between body and of the stomach antrum. No intra or postoperative complications were encountered and the patient was discharged home on day 5 after drains removal and feeding. Modified roux en y hepaticojejunostomy to permit transgastric. Surgery department, university of antioquia school of medicine. A critical evaluation is made of 1 patients submitted to choledocho or hepaticojejunostomy. Biliaryenteric anastomosis especially roux en y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. Longterm biliary function after reconstruction of major. Roux en y hepaticojejunostomy ryhj or hepaticodudenostomy hd is the most commonly used techniques for biliary. One hundred forty patients with rouxeny hj and 19 with hjd were followed with barium meal and endoscopy. Using a short enteroscope 152 cm and commercially available endoscopic retrograde cholangiography accessories, biliary interventions were performed in. The diagnosis of acute cholangitis caused by mechanical obstruction of the jejunal loop of hj was made, leading to the decision to perform a laparotomy. Roux en y hepaticojejunostomy is the standard procedure used by most hepatobiliary surgeons for biliary reconstruction following iatrogenic bile duct injury, benign and malignant cbd strictures, choledochal cysts and biliary tract tumors management.
Unfortunately he suffered a right hepatic artery rha injury along with a transection of his common bile duct. Primary cyst excision combined with biliary reconstruction is the standard treatment of choledochal cysts. Laparoscopic excision of choledochal cyst with intracorporeal roux en y hepaticojejunostomy for chol duration. It may be performed as a palliative bypass procedure. Rouxeny biliary reconstruction david lee joohyun kim definition roux en y hepaticojejunostomy ryh was described by cesar roux in 1926 to reconstruct drainage of the esophagus following a total gastrectomy. Roux en y hepaticojejunostomy technique is a commonly performed during biliary reconstruction. A roux en y say roo en why gastric bypass is surgery to make the stomach smaller and change the connection between the stomach and the intestines. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Biliary reconstruction in liver transplant patients with. Initially, a ptcd and balloon dilation of the stricture should be performed, as it is a simple and effective procedure. The main indications for hepaticojejunostomy were iatrogenic strictures of cbd 60 patients, and choledocholithiasis with markedly dilated duct 41 patients. The multiple roux en y hepaticojejunostomy reconstruction by formation of a hilar bile duct lake technique is safe and effective to use in the surgical treatment of hilar cholangiocarcinoma, and thus provides a reasonable choice for biliary surgeons to perform cholangiojejunostomy reconstruction in the radical operation of hilar. After pancreatic surgery hepaticojejunostomy hj stricture is a rare condition. After laboratory and image analysis, diagnosis of intrahepatic lithiasis was con.
Roux en y laparoscopic pancreaticojejunostomy for chronic pancreatitis juan toro, md, jesus vasquez, md, carlos lopera, md, sergio diaz, md, jean vergnaud, md, andres ricardo. This chapter lists the indications, essential steps, common technical variations, and complications of the procedure. Pdf rouxeny hepaticojejunostomy with subcutaneous access. The procedure involves cutting the stomach in two to create a pouch out of the smaller proximal near portion of the stomach, attaching it to the small intestine. Typically, it is between stomach and small bowel that is distal or further down the gastrointestinal tract from the cut end. The patient had right upper quadrant pain for several months and has been referred to our center for the bile duct dilatation detected on ultrasound. Weight loss can cause deposits in the gallbladder called gallstones. Treatment of failed rouxeny hepaticojejunostomy after. Background choledochojejunostomy is an anastomosis of the common bile duct to the jejunum, performed to relieve symptoms of biliary obstruction and restore continuity to the biliary tract.
The hepaticojejunostomy technique with intraanastomotic. An incidence of 5% postoperative duodenal ulcer was noted in the first group, while no ulcer was seen in the patients with hjd. However, its longterm outcome is still far from satisfactory management of bile duct injuries. Indisputable tenets of this procedure include the creation of a durable jejunojejunostomy, followed by the creation of a tensionfree anastomosis between the hepatic duct and the defunctionalized jejunal limb. Transjejunal laparoscopic assisted ercp in a patient with. Longterm results of rouxeny hepaticojejunostomy and. Laparoscopic choledochal cyst excision and rouxeny. Anesthesia standardization for laparoscopic gastric bypass. The overall mortality rate was 4% representing principally renal hepatic failure, bile peritonitis and bleeding. Annals of pediatric surgery, vol 1, no 1, october 2005. Rouxeny hepaticojejunostomy technique is a commonly performed during biliary reconstruction.
Usually, management is conservative, while operative revision redo is only rarely performed. Rouxeny hepaticojejunostomy ryhj is the most wellaccepted treatment for most post cholecystectomy bile duct injuries bdi. Survival and quality of life after bile duct reconstruction for. Pdf incidence of hepaticojejunostomy stricture after. Longterm results of rouxeny hepaticojejunostomy and hepaticojejunoduodenostomy g. Pdf longterm results of rouxeny hepaticojejunostomy and. The surgery limits the amount of food the stomach can hold. Pp 7985 original article roux eny hepaticojejunostomy versus hepaticodudenostmy for biliary. Patients with a history of a previous rouxeny hepaticojejunostomy or choledochojejunostomy who are seen with cholangitis present a complex situation see chapters 31 and 42. In the setting of liver transplantation, the ryh is an. Hypothesis normal biliary function can be achieved after reconstruction for major bile duct injuries using either hepaticoduodenostomy hd or roux en y hepaticojejunostomy hj design retrospective analysis of consecutive patients requiring biliary enteric reconstructions from february 1, 1993, through january 1, 2002, for bile duct injuries. Pdf rouxeny hepaticojejunostomy versus hepaticodudenostmy.
External metallic circle in hepaticojejunostomy bmc. Pdf the need to control recurrent biliary strictures implies the practice of repeated major surgical procedures. We have adopted the multiple roux en y hepaticojejunostomy reconstruction by formation of a bile duct lake technique in the treatment of hilar cholangiocarcinoma since 2008, and obtained satisfactory short and longterm results. At intervention, a solid mass was palpated in the roux en y jejunal limb, just bellow its passage through the transverse mesocolon and approximately 40 cm above the enteroenterostomy. To present an option technique during the accomplishment of a roux eny. Find hepaticojejunostomy information, treatments for hepaticojejunostomy and hepaticojejunostomy symptoms. In the experience of lindenatier11 hepaticojejunostomy was not associated with an increased. Abdelrafee et al carried out a retrospective cohort study in which 120 patients with postcholecystectomy bile duct injuries that were treated by means of roux en y hepaticojejunostomy were followed for a mean of 149 months range, 70246. Surgical revision of hepaticojejunostomy strictures after. Biliary obstruction can be caused by pathology above, at, or below the level of the cystic duct. Rouxeny biliary reconstruction plastic surgery key.
The main causes of cholangitis following roux en y hepaticojejunostomy in healthy liver, namely, i stenosis of the biliary anastomosis, and ii ascending cholangitis favored by a bowel loop that is too short, were ruled out in the present case. Biliary ascariasis after roux en y hepaticojejunostomy. Application of multiple rouxeny hepaticojejunostomy. Rouxeny laparoscopic pancreaticojejunostomy for chronic. Laparoscopic excision of choledochal cyst type i and roux. Rouxeny definition of rouxeny by the free dictionary. In reversing the gastric bypass, the roux limb is disconnected from the gastrojejunostomy and the gastric pouch is anastomosed to the gastric remnant. The roux limb will be created by dividing the jejunum about 1520 cm downstream from the ligament of trietz. Rouxeny hepaticojejunostomy ryhj is the most common form of reconstruction of the biliary pathway. This article will focus on the gastrointestinal complications of rouxen y gastric bypass rygb. In this study, we present the results of hepaticojejunostomy with external metallic circle. The hepaticojejunostomy technique with intraanastomotic stent in. This video describes a roux en y hepaticojejunostomy biliary reconstruction technique.
In the major bdis, a rouxeny hepaticojejunostomy hj is the preferred method of repair as was performed in all patients in this study. My fiance had a lapo gallbladder procedure a year ago. Early complications are defined as those occurring within 2 weeks postoperatively or within 30 days of the surgery. The mortality, morbidity, and the incidence of postoperative anastomotic stenosis were comparable in both groups. Gastrointestinal complications of rouxeny gastric bypass.
Herein, laparoscopic excision of a type 1 common bile duct cyst and roux en y hepaticojejunostomy technique in a 37yearold male patient is presented with an accompanying videoclip. Roux en y gastric bypass, like all bariatric surgeries, is designed to cause a large amount of weight loss. Performing such a major procedure, in laparoscopic means, allowed for faster patient recovery and discharge, with less morbidity. Rouxeny hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal. Standardization of the anesthesia for fully stapled laparoscopic roux en y gastric bypass surgery jpmulier, p van lancker, b dillemans, s van cauwenberge international anesthesia submitted for public 2010, abstract. The purpose of this study was to determine the feasible and safe of the laparoscopic excision with roux en y hepaticojejunostomy and evaluate the shortterm outcomes after treatment for children with choledochal cyst. Roux en y hepaticojejunostomy has been the most commonly used approach for biliary reconstruction, especially in cases of duct transaction injury 14.
Rouxeny hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries 1. The creation of a rouxeny ry hepaticojejunostomy hj is a critical component of many types of hepatobiliary operations. Roux en y hepaticojejunostomy ryhj is the most common form of reconstruction of the biliary pathway. The aim of this study was to evaluate the feasibility of short dbe for managing biliary disorders in patients with a roux. The decision to perform a transjejunal laercp was made due to the complex anatomy in this patient. Roux eny hepaticojejunostomy or choledochojejunostomy biliary enteric anastomosis is performed for selected cases of biliary stricture, bile duct injury, or bile duct tumor. This configuration of the intestines has been applied for biliary reconstruction following bile duct excision.
Endoscopic access loop with bilioenteric anastomosis. This was an observational cohort design that analyzed the outcome of patients who had a surgical revision of hj strictures after pancreatic surgery at a specialized pancreatic center. It is a time honoured, durable, less resource intensive and a defi nitive procedure. Restriction and malabsorption roux en y gastric bypass uses these methods to cause. Six months after surgery, the patient had no recurrence of cholangitis. Biliary reconstruction options for bile duct stricture in. To prevent this, the gallbladder may be removed during your surgery or at a later date. Roux en y hepaticojejunostomy is effectiveness in pediatric patients 8. The sidetoside roux en y hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel.
A surgical procedure which may be done for severe obesity. A distance of 40 cm will be measured distal to the efferent cut end and the afferent limb will be anastomosed at this point. Between january 1992 to december 2007, 120 patients with postcholecystectomy bile duct injury surgically treated by hepaticojejunostomy roux en y were followed up for 20 years in mansoura gastro. Hepatojejunostomy an overview sciencedirect topics. The roux limb is passed retrocolic to create the hj.
Society of american gastrointestinal and endoscopic surgeons sages 7,587 views. Y hepaticojejunostomy in patients with primary sclerosing cholangitis who had undergone liver transplant in shiraz organ transplant center. Rouxeny synonyms, rouxeny pronunciation, rouxeny translation, english dictionary definition of rouxeny. In general surgery, a rouxeny anastomosis, or roux en y, is an endtoside surgical anastomosis of bowel used to reconstruct the gastrointestinal tract. Hepaticojejunostomy with external metallic circle were performed in eight male spraguedawley rats. The bariatric surgical procedure requires specific anesthesia and pharmacologic knowledge. The sidetoside rouxeny hepaticojejunostomy is carried through.
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