title: Outcome of hepaticojejunostomy without access loop for repair of iatrogenic bile duct injury at laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Roux-en-Y hepaticojejunostomy is the accepted treatment for transectional biliary injury at cholecystectomy. Many authors advocate leaving a long redundant jejunal access loop to facilitate subsequent access. Reasoning that percutaneous access can be achieved transhepatically in patients with stenosis, this study reports the outcome of a policy of biliary repair without the use of a jejunal access loop.
  
  
  METHODS
  Eleven patients undergoing biliary reconstruction over a 5-year period constituted the study population. Three (27%) were male, and the median (range) age at injury was 53 (26-75) years. Median delay from injury to repair was 2 (1-48) months. Bismuth stage was: stage I, 4; stage II, 5; and stage III, 2. Four patients had concomitant arterial injury. All underwent surgical repair by Roux-en-Y hepaticojejunostomy without an access loop.
  
  
  RESULTS
  The median follow-up was 13 (1-64) months. The principal postoperative complication was a hepatic abscess in one patient. There was one death during follow-up, from acute myeloid leukemia. One patient (9%) with a type III injury presented with a symptomatic recurrent biliary stricture 6 months after repair, and was successfully managed by percutaneous biliary dilatation, using a combination of transhepatic and jejunal loop puncture.
  
  
  CONCLUSIONS
  Successful biliary reconstruction can be performed without a routine jejunal access loop.
authors.affiliation: Hepatobiliary Unit, Department of Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Barrow
authors.forename: Ajith K
authors.initials: AK
authors.lastname: Siriwardena
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D001649:Bile Duct Diseases / Q000145:classification / Q000209:etiology; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010166:Palliative Care