title: Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury.
abstract: 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.
authors.affiliation: Department of Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Road, Shanghai 200025, China.
authors.forename: Ji-Qi
authors.initials: JQ
authors.lastname: Yan
authors.forename: Cheng-Hong
authors.initials: CH
authors.lastname: Peng
authors.forename: Jia-Zeng
authors.initials: JZ
authors.lastname: Ding
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Yang
authors.forename: Guang-Wen
authors.initials: GW
authors.lastname: Zhou
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Chen
authors.forename: Zong-Yuan
authors.initials: ZY
authors.lastname: Tao
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Li
mesh_terms: 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