Hepaticojejunostomy using a Roux-en-Y jejunal limb via the retrocolic-retrogastric route.
BACKGROUND
Hepaticojejunostomy following hepatobiliary resection has been performed using a Roux-en-Y jejunal limb via the antecolic or the retrocolic-anteduodenal route. However, in morbidly obese patients difficulty arises from the thickened, foreshortened mesentery of the jejunum and from limited mobility due to intra-abdominal fat deposition.


METHODS
We developed new placement of Roux-en-Y jejunal limb in which the limb is placed via the retrocolic-retrogastric route. Hepaticojejunostomy via this route was performed in 133 obese and nonobese patients with biliary cancer.


RESULTS
Tension-free anastomosis was successfully performed in all patients. Neither early nor late complications directly related to this new reconstruction route occurred.


CONCLUSIONS
The retrocolic-retrogastric route is simple and an alternative to the standard methods of biliary reconstruction following hepatobiliary resection. This new placement may circumvent the obesity-related problem.
Nagino
Masato
M
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466, Japan. nagino@med.nagoya-u.ac.jp
Kamiya
Junichi
J
Kanai
Michio
M
Uesaka
Katsuhiko
K
Sano
Tsuyoshi
T
Arai
Toshiyuki
T
Nimura
Yuji
Y
D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D001661:Biliary Tract Neoplasms / Q000150:complications* / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications* / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000601:surgery*; D008297:Male; D009765:Obesity / Q000150:complications*; D013536:Suture Techniques; D016896:Treatment Outcome