Publication:

Jejunoduodenal anastomosis as permanent biliary access loop post-hepaticojejunostomy: our experience

Background Post-hepaticojejunostomy stricture is a common problem may result in liver cirrhosis and portal hypertension and death if not treated. Different modalities to repair it are available including endoscopic management that needs access loop (including jejuno-duodenal access loop) to reach the site of stricture.

Methods This prospective study was done in general surgery department, faculty of medicine, Zagazig University hospitals during the period from January 2016 to December 2018. The study included 23 patients (18 females and 5 males) all needed hepaticojejunostomy to treat biliary injuries during cholecystectomy, biliary stricture post-cholecystectomy or post-hepaticojejunostomy anastomotic stricture. Their ages ranged between 26 to 57 ys with mean age 37.3±5.1. The postoperative course of patients and the feasibility of postoperative endoscopic access to the hepaticojejunostomy and intrahepatic ductal system were assessed.

Results This study included 23 patients (18 females and 5 males) where 19 (82.6%) patients were presented post-cholecystectomy and 4 (17.4%) patients post-hepaticojejunostomy, with different modes of presentation postoperative complications included; 2 patients complicated with chest infection, 3 (13%) patients with wound seroma and infection, 2 (about 8.7%) patients complicated with biliary gastritis and 1 (about 4.4%) patient with mild attack of cholangitis. There was no anastomotic leakage or mortality in the studied group. The trial of access to the hepaticojejunostomy using gastroduodenoscopy was successful in all cases with ease including trial of balloon dilatation. The average hospital stay ranged between 5-7 days.

Conclusions Side-to-side jejunoduodenal anastomosis is a very useful technique as it provides good endoscopic access to hepaticojejunostomy and the intrahepatic ducts and needs more application and further evaluation.