Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury.
OBJECTIVE
To discuss the surgical method and skill of biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury.


METHODS
From November 2005 to December 2006, eight patients with biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury were admitted to our hospital. Their clinical data were analyzed retrospectively.


RESULTS
Bile duct injury was caused by cholecystectomy in the eight cases, including seven cases with laparoscopic cholecystectomy and one with mini-incision choleystectomy. According to the classification of Strasberg, type E1 injury was found in one patient, type E2 injury in three, type E3 injury in two and type E4 injury in two patients. Both of the type E4 injury patients also had a vascular lesion of the hepatic artery. Six patients received Roux-en-Y hepaticojejunostomy for the second time, and one of them who had type E4 injury with the right hepatic artery disruption received right hepatectomy afterward. One patient who had type E4 injury with the proper hepatic artery lesion underwent liver transplantation, and the remaining one with type E3 injury received external biliary drainage. All the patients recovered fairly well postoperatively.


CONCLUSIONS
Roux-en-Y hepaticojejunostomy is still the main approach for such failed surgical cases with bile duct injury. Special attention should be paid to concomitant vascular injury in these cases. The optimal timing and meticulous and excellent skills are essential to the success in this surgery.
Yan
Ji-Qi
JQ
Department of Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Road, Shanghai 200025, China.
Peng
Cheng-Hong
CH
Ding
Jia-Zeng
JZ
Yang
Wei-Ping
WP
Zhou
Guang-Wen
GW
Chen
Yong-Jun
YJ
Tao
Zong-Yuan
ZY
Li
Hong-Wei
HW
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002779:Cholestasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies