title: Recommendations for preventing complications related to Roux-en-Y hepatico-jejunostomy performed during excision of choledochal cyst in children.
abstract: 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.
authors.affiliation: Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shimotakahara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Okada
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Yanai
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Masahiko
authors.initials: M
authors.lastname: Urao
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyano
mesh_terms: 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