Background & Aim: Roux-en-Y hepaticojejunostomy (RYHJ) is the most common treatment done for benign biliary strictures and as a part of for post CDC excision biliary drainage. In the long term follow up, RYHJ stenosis is a dreaded complication, both for the patients and the attending surgeon, in view of the complexity and difficulty in its management. This is traditionally managedby a combination of medical, radiological and open surgical techniques. There are only a few reports describing the management of strictured biliary anastomosis by a laparoscopic technique. The aim of the present study is to describe our experience of laparoscopic re- establishment of biliary continuity(Re-do hepatico-jejunostomy)
Methods: Retrospective analysis of prospectively collected data of RYHJ stenosis post benign biliary stricture (BBS) repair and choledochal cyst (CDC) excision, treated by laparoscopic re-do RYHJ, between January 2018 to December 2018 in the department of GI Surgery, GB Pant Institute & Maulana Azad Medical College.
Results: 6 patients underwent laparoscopic Re-do RYHJ during the study period. 4 patients developed RYHJ stenosis post open BBS repair and 2 after open CDC excision. The presenting complaints was repeated episodes of fever with jaundice, refractory to medical management. Three patients also had hepatolithiasis.
Two patients had BBS type 2 and two had type 3 stricture for which RYHJ was done previously. No patient had documented bile leak in the immediate post-operative period following RYHJ. Median age of the patients was 32 years with 4 females and 2 males in the group. Median time between RYHJ and re-do RYHJ was 20 months. One of the patients presented to us 15 years after BBS repair with H-J stenosis. Cases not amenable to radiological/ endoscopic intervention were taken up for surgery.
The median duration of Re-do RYHJ surgery was 160 minutes (140-210) with median intraoperative blood loss of 100 ml. Time to resume oral diet was 2 days and duration of postoperative hospital stay was 6 days (4-9).Immediate post-operative period was uneventful. Median follow up period is 7 months. One of the patients in the follow up, presented with complains of episodes of fever with MRI abdomen suggestive of mild intra hepatic biliary radicle dilatation after 4 months of Re-do RYHJ. HIDA scan was done in the patient with normal hepatocyte function with no hold up of dye at the Re-do RYHJ site. She was started on medical management to which she responded well with patient being asymptomatic till now.
Conclusion: Laparoscopic Re-do Hepatico-Jejunostomy is a feasible procedure for RYHJ stenosis with shortened period of hospital stay and good post-operative outcomes.