title: Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries.
abstract: BACKGROUND
  Roux-en-Y hepaticojejunostomy (RYHJ) is the most well-accepted treatment for most post-cholecystectomy bile duct injuries (BDI). RYHJ failure is a complex situation that requires expert planning and the possibility of using a combination of operative, radiologic, and endoscopic techniques. The aim of this study was to report our experience with a multidisciplinary approach to failed RYHJ after post-cholecystectomy BDI.
  
  
  METHODS
  Between January 1996 and March 2008, 44 consecutive patients were managed for RYHJ failure in our department. They presented with recurrent cholangitis in 40 patients (91%) and/or jaundice in 9 (20%). First-line treatment consisted of primary revisionary surgery in 26 cases (59%; repeat RYHJ in 22 and hepatectomy in 4) and a percutaneous approach in 18 cases (41%; biliary interventions in 16 and portal vein embolization in 2).
  
  
  RESULTS
  Postoperative mortality was nil. Postoperative morbidity was 11% after repeat RYHJ without hepatectomy, 80% (bile leaks) after hepatectomy, and 10% (mild cholangitis and hemobilia) after a percutaneous approach. Delayed revisionary surgery with the intent to wait for bile duct dilation failed in all 5 patients. With a mean follow-up of 49 ± 40 months, second- or third-line treatment was attempted in 7 patients (16%). One patient (2%) died because of suicide. Overall clinical success defined by the absence of incapacitating biliary symptoms after treatment was achieved in 39 patients (89%).
  
  
  CONCLUSIONS
  An immediate, multidisciplinary approach including repeat biliary surgery and/or a percutaneous approach in a tertiary hepatobiliary center is required to obtain good, long-term results when treating the failure of RYHJ post-cholecystectomy BDI.
authors.affiliation: AH-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
authors.forename: Amine
authors.initials: A
authors.lastname: Benkabbou
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects*; D041761:Cholecystolithiasis / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D017211:Treatment Failure; D055815:Young Adult