title: Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass.
abstract: Introduction. Most surgeons prefer Roux-en-Y hepaticojejunostomy (RYHJ) for biliary reconstruction following a common bile duct (CBD) injury. However, in patients with a Roux-en-Y gastric bypass (RYGB) a RYHJ may be technically challenging and can interfere with bowel physiology induced by RYGB. The use of a hepaticoduodenostomy (HD) resolves both these issues. Presentation of Case. We present a case of CBD injury during laparoscopic cholecystectomy one year after laparoscopic RYGB for morbid obesity. Due to adhesions and previous surgery with RYGB, we did not want to interfere with the RYGB physiology by anastomosing the CBD to the jejunum or ileum. Succeeding a full Kocher's maneuver we performed biliary reconstruction by a tension-free end-to-side HD. The postoperative recovery was uneventful and the patient was discharged after eight days. At four-month follow-up, the patient had stable weight and normal laboratory test results. MRCP demonstrated normal intra- and extrahepatic bile ducts with status after HD. Discussion. We propose that HD should be considered in treatment of CBD injury in post-RYGB patients as it may reduce the risk of interfering with the post-RYGB physiology.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Sheraz
authors.identifier: 0000-0002-5696-2319
authors.initials: S
authors.lastname: Yaqub
authors.affiliation: Department of Gastrointestinal Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Mala
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Oystein
authors.identifier: 0000-0003-3536-0375
authors.initials: O
authors.lastname: Mathisen
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Bjørn
authors.identifier: 0000-0002-3137-6225
authors.initials: B
authors.lastname: Edwin
authors.affiliation: Department of Transplantation Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Bjarte
authors.identifier: 0000-0002-2874-236X
authors.initials: B
authors.lastname: Fosby
authors.affiliation: Department of Radiology, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Dag Tallak Kjærsdalen
authors.initials: DT
authors.lastname: Berntzen
authors.affiliation: Department of Radiology, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Andreas
authors.identifier: 0000-0002-5501-259X
authors.initials: A
authors.lastname: Abildgaard
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, Norway.
authors.forename: Knut Jørgen
authors.identifier: 0000-0001-6777-7955
authors.initials: KJ
authors.lastname: Labori