Long-term outcome of gastric access loop in hepaticojejunostomy.
BACKGROUND
The incidence of hepaticojejunostomy stricture is 4%-10% in experienced centres. Many access loops have been designed and used to facilitate endoscopic intervention for this complication of hepaticojejunostomy. In this study, we investigated the effectiveness and safety of gastric access loop.


METHODS
A retrospective analysis was conducted on 13 patients who had undergone hepaticojejunostomy with gastric access loop between June 1999 and September 2003. Eleven patients were followed up for a mean period of 51 months (range 20-81 months). Two patients were lost to follow up.


RESULTS
On follow-up, 8 patients had patent jejunogastrostomy (end to side anastomosis between Roux loop of jejunum and stomach) and hepaticojejunostomy. Three patients developed stricture of jejunogastrostomy at 41 months, 63 months and 81 months of follow-up. Among these 3 patients, one also had hepaticojejunostomy stricture. In the patient with hepaticojejunostomy stricture, dilatation of jejunogastrostomy stricture was attempted but failed. None of the patients had any evidence of bile gastritis/cholangitis. There was no procedure related morbidity/mortality.


CONCLUSIONS
Further studies involving large numbers of patients are required before wide application of gastric access loop in hepaticojejunostomy though it is a safer option than percutaneous transhepatic manipulations or revision surgery.
Selvakumar
Eswaran
E
Department of Surgical Gastroenterology, Government Stanley Medical College Hospital, The Tamilnadu Dr. M.G.R. Medical University, Chennai-600001, Tamilnadu, India. dreselva@hotmail.com
Rajendran
Shanmugasundaram
S
Balachandar
Tirupporur G
TG
Kannan
Devy Gounder
DG
Jeswanth
Satyanesan
S
Ravichandran
Palaniappan
P
Surendran
Rajagopal
R
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002758:Cholangiography; D005260:Female; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome