title: Hepaticojejunostomy using a Roux-en-Y jejunal limb via the retrocolic-retrogastric route.
abstract: 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.
authors.affiliation: 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
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Junichi
authors.initials: J
authors.lastname: Kamiya
authors.forename: Michio
authors.initials: M
authors.lastname: Kanai
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Arai
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: 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