Hepatobiliary scintigraphy after biliary reconstruction-Roux Y and RY-DJ.
OBJECTIVE
Reconstruction of extrahepatic biliary tract with benign lesion still has some unsettled problems, such as postoperative cholangitis. This study was conducted to compare bile through the remnant alimentary tract in patients undergoing Roux-Y-duodenojejunal anastomosis (RY-DJ) which was designed for decompressing the jejunal limb of R-Y and for allowing an inflow of bile into the duodenum, and those undergoing Roux-Y choledochojejunostomy (R-Y), using hepatobiliary scintigraphy.


METHODS
Five normal human volunteers and 20 patients underwent R-Y (n=14), RY-DJ (n=6), using hepatobiliary scintigraphy.


RESULTS
Postoperative cholangitis developed in 2 patients (14%) with R-Y and none with RY-DJ. Hepatobiliary scintigraphy showed prominent stasis of 99mTc in the proximal jejunum loop of the patients who underwent R-Y, which was not found in the upper jejunum of the patients with RY-DJ. The time taken before visualization of 99mTc at the upper jejunum in the patient who underwent R-Y (65 +/- 5 min) was significantly longer than that in the healthy control (40 +/- 5 min). On the other hand, the time taken before visualization of 99mTc at the upper jejunum in RY-DJ (45 +/- 5 min) was similar to that of healthy controls.


CONCLUSIONS
These data suggested that this new method (RY-DJ) for reconstructing the extrahepatic biliary tract was more physiological with less postoperative complications than R-Y.
Hashimoto
Naoki
N
Department of Surgery, Kinki University School of Medicine, Maikodai Hospital, Japan. Hashiline@aol.com
Kotoura
Yoshinao
Y
Ohyanag
Harumasa
H
D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging*; D015529:Choledochal Cyst / Q000000981:diagnostic imaging / Q000601:surgery; D002768:Choledochostomy; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000601:surgery; D004385:Duodenostomy; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging; D007582:Jejunostomy; D007583:Jejunum / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging