Recommendations for preventing complications related to Roux-en-Y hepatico-jejunostomy performed during excision of choledochal cyst in children.
OBJECTIVE
The aim of this study was to review the outcome of a protocol the authors proposed for preventing Roux-en-Y hepatico-jejunostomy (RYHJ) related complications.


METHODS
In 1986 the authors adopted the following protocol for improving RYHJ to minimize risks for RY-related complications: (1) end-to-end anastomosis if possible; (2) if end-to-side anastomosis is unavoidable, the common hepatic duct should be anastomosed as close as possible to the closed end of the blind pouch (BP); (3) careful selection of the vascular supply to the RY jejunal limb; (4) length of the RY jejunal limb should not be predetermined, but individualized; (5) approximate the native jejunum to the RY limb. The authors reviewed 92 children who had surgery for CC (mean age at surgery, 4.1 years) at our institution between 1986 and 2002 to assess the effectiveness of their recommendations.


RESULTS
After the adoption of the authors' recommendations for RYHJ, they have experienced no RYHJ-related complications after a mean follow-up period of 7.6 years (range, 4 months to 16 years).


CONCLUSIONS
RYHJ in children is different from that in adults, because the RY limb or BP can grow and elongate as the child grows. The authors' recommendations appear to have successfully prevented RY-related complications up to the time of this review, and they highly recommend their use.
Yamataka
Atsuyuki
A
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Kobayashi
Hiroyuki
H
Shimotakahara
Akihiro
A
Okada
Yasuhiro
Y
Yanai
Toshihiro
T
Lane
Geoffrey J
GJ
Urao
Masahiko
M
Miyano
Takeshi
T
D000293:Adolescent; D000713:Anastomosis, Roux-en-Y; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000601:surgery*; D006801:Humans; D007223:Infant; D007582:Jejunostomy; D008099:Liver / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies