Treatment of failed rouxeny hepaticojejunostomy after post. D biliary reconstruction, and 260 patients had a roux. The sidetoside rouxeny hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel. Multiple studies examining the longterm outcome of biliary. Five ports 4 robotic trocars including 12mm camera port, and 12mm accessory port were used for the excision of this type i choledochal cyst with rouxeny hepaticojejunostomy reconstruction. The technique involves the incorporation of a cutaneous access stoma in the roux. For the sake of comparison, patients were divided into 2.
Four patients 1 ic and 3 iva cysts had hepatic duct stricture around the hepatic hilum. Hepaticojejunostomy complications gallbladder community oct 16, 2016 hi. A surgical procedure which may be done for severe obesity. The types are divided based on the procedures of the surgery. The procedure involves cutting the stomach in two to create a pouch out of the smaller proximal near portion of the stomach, attaching it to the small intestine, bypassing a large part of the stomach and all of the duodenum. Rouxeny hepaticojejunostomy ryhj is currently con sidered as the definitive treatment for iatrogenic bile duct injuries 1. This medical image is titled rouxeny hepaticojejunostomy exhibit number. Get a printable copy pdf file of the complete article 2. Since this patient was a thin lady with a body mass index of 17 and a narrow costal margin, thus the design of the trocar ports needed to be more. Rouxeny hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal representative of biliary diversion procedures. A reappraisal of its indications and results article pdf available in annals of surgery 1812. After gastric bypass, swallowed food will go into this small pouch of stomach and then directly into the small intestine. A new technique of hepaticojejunostomy is described.
Using a short enteroscope 152 cm and commercially available endoscopic retrograde cholangiography accessories, biliary interventions were performed in. Mar 09, 2016 one of the most popular options is roux en y gastrojejunostomy. The aim of this study was to evaluate the feasibility of short dbe for managing biliary disorders in patients with a roux. Jul 24, 2016 roux en y biliary reconstruction david lee joohyun kim definition roux en y hepaticojejunostomy ryh was described by cesar roux in 1926 to reconstruct drainage of the esophagus following a total gastrectomy. A 52yearold man underwent laparoscopic cholecystectomy at. Especially after roux en y gastric bypass rygb, conventional ercp is rarely successful in patients with symptomatic choledocholithiasis.
The results of the longterm followup of 202 patients with roux en y hepaticojejunostomy roux en y hj and 19 with hepaticojejunoduodenostomy hjd are reported. Many studies have reported the shortterm outcome following hj. Management of duct to duct biliary anastomotic stricture with modified roux en y hepaticojejunostomy in. Biliary reconstruction and rouxeny hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury. Purchase the right to use this exhibit in litigation. My fiance had a lapo gallbladder procedure a year ago.
Roux en y hepaticojejunostomy ryhj or hepaticodudenostomy hd is the most commonly used techniques for biliary. Excision of choledochal cyst in children by rouxeny. Robotic assisted excision of type i choledochal cyst with. Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. Sidetoside enteroenterostomy anastomosis was created outside abdominal cavity. Anastomotic stricture is a complex and substantial complication following rouxeny hepaticojejunostomy. Recently, a telemanipulative robotic surgical system was introduced, providing laparoscopic instruments with wristarm technology and 3dimensional visualization of the operative.
Biliaryenteric anastomosis especially roux en y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. Biliary ascariasis after rouxeny hepaticojejunostomy by l. Rouxeny biliary reconstruction plastic surgery key. The hepaticojejunostomy technique with intraanastomotic stent in. Rouxeny hepaticojejunostomy or choledochojejunostomy. Rouxeny hepaticojejunostomy technique is a commonly performed during biliary reconstruction. After completion of the anastomosis, the robotic system was undocked and small upper midline incision was made. View the article pdf and any associated supplements and figures for a period of 48 hours. The procedure involves cutting the stomach in two to create a pouch out of the smaller proximal near portion of the stomach, attaching it to the small intestine.
Primary cyst excision combined with biliary reconstruction is the standard treatment of choledochal cysts. Longterm results of rouxeny hepaticojejunostomy and. The mortality, morbidity, and the incidence of postoperative anastomotic stenosis were comparable in both groups. Surgical management consisted of a rouxeny hepaticojejunostomy. This video presents a robotic left hepatectomy and rouxeny hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. The results achieved with this technique, which was performed in 26 patients, were about the same following hepaticojejunostomy. Eusguided hepaticojejunostomy with transjejunal peroral cholangioscopy and electrohydraulic lithotripsy in a patient with complicated choledocholithiasis after roux en y gastric bypass videogie. However, the use of available endoscopic retrograde cholangiography accessories during this procedure is limited because of the length of the conventional instrument 200 cm. In the setting of liver transplantation, the ryh is an. Robotassisted complete excision of choledochal cyst type. Biliary reconstruction br is commonly performed for benign and malignant diseases of the hepatobiliary system. This medical image is titled roux en y hepaticojejunostomy exhibit number. This chapter lists the indications, essential steps, common technical variations, and complications of the procedure. External metallic circle in hepaticojejunostomy bmc surgery.
Total console time of 4 hours with minimal blood loss and no requirement for transfusion with length of stay of 3 days. Hepaticojejunostomy hj roux en y is the preferred method of surgical treatment of most of major bdi. Initially, a ptcd and balloon dilation of the stricture should be performed, as it is a simple and effective procedure. Rouxeny hepaticojejunostomy with subcutaneous access and the. Laparoscopic surgery comprising excision of the extrahepatic bile duct and wide roux en y hepaticojejunostomy with ductoplasty was performed by using four trocars. Patients with a history of a previous rouxeny hepaticojejunostomy or choledochojejunostomy who are seen with cholangitis present a complex situation see chapters 31 and 42.
Choledochal cyst is a relatively rare congenital disease. Pdf rouxeny hepaticojejunostomy with subcutaneous access. A rouxeny loop of at least 40 cm length was used carefully. Objective the aim of this study was to evaluate factors affecting the operating time for complete cyst excision and rouxeny hepaticojejunostomy in paediatric cases of congenital choledochal malformation ccm. Especially after rouxeny gastric bypass rygb, conventional ercp is rarely successful in patients with symptomatic choledocholithiasis.
It is a common operation, not only to bypass extrahepatic biliary obstructions, but also to establish biliaryenteric continuity after resections for benign and malignant diseases. Hypothesis normal biliary function can be achieved after reconstruction for major bile duct injuries using either hepaticoduodenostomy hd or rouxeny hepaticojejunostomy hj design retrospective analysis of consecutive patients requiring biliary enteric reconstructions from february 1, 1993, through january 1, 2002, for bile duct injuries. Hypothesis normal biliary function can be achieved after reconstruction for major bile duct injuries using either hepaticoduodenostomy hd or roux en y hepaticojejunostomy hj. This technique has met many milestones of extensive evolution, particularly the last years of concomitant technological evolution laparoscopicrobotic approach. Patients with a history of a previous roux en y hepaticojejunostomy or choledochojejunostomy who are seen with cholangitis present a complex situation see chapters 31 and 42. Design a 3year retrospective study was undertaken between january 20 and december 2015 in four centres in china. Biliary reconstruction and rouxeny hepaticojejunostomy for the. Roux en y hepaticojejunostomy or choledochojejunostomy biliary enteric anastomosis is performed for selected cases of biliary stricture, bile duct injury, or bile duct tumor. Jun 21, 2010 the aim of this study was to evaluate the feasibility of short dbe for managing biliary disorders in patients with a roux. We present a case of early robotassisted repair of a strasberg class e 1 bile duct injury with rouxeny hepaticojejunostomy. In roux en y gastric bypass surgery, the surgeon fashions an alternate eggsized pouch, which is joined with the small intestine, so food skips the upper stomach and goes straight to the pouch. We present a case of early robotassisted repair of a strasberg class e 1 bile duct injury with roux en y hepaticojejunostomy. For choledochal cyst type i, complete excision of cyst with rouxeny hepaticojejunostomy anastomosis is the treatment of choice. Rouxeny laparoscopic pancreaticojejunostomy for chronic.
The creation of a roux en y ry hepaticojejunostomy hj is a critical component of many types of hepatobiliary operations. No intra or perioperative complications of the surgery were noted. Longterm biliary function after reconstruction of major. Five ports 4 robotic trocars including 12mm camera port, and 12mm accessory port were used for the excision of this type i choledochal cyst with roux en y hepaticojejunostomy reconstruction. A distal jejunal loop of approximately 10,0 to 15,0 cm must be kept far from the anastomosis that allows its setting, without tension, in the anterior gastric wall bellow the small bending, between body and the stomach antrum figure 1. Gianturco stents for the management of biliary tract strictures. Laparoscopic rouxeny hepaticojejunostomy for benign. The operation was completed laparoscopically for all patients. In this study, we present the results of hepaticojejunostomy with external metallic circle. Mar 29, 2017 calcium oxalate nephropathy is rare in current practice. Total cyst excision and rouxeny hepaticojejunostomy is the standard procedure for choledochal cyst 4. Unfortunately he suffered a right hepatic artery rha injury along with a transection of his common bile duct. Choledochojejunostomy an overview sciencedirect topics. Rouxeny hepaticojejunostomy is a common surgical procedure used to bypass extrahepatic biliary obstructions and to establish biliaryenteric continuity after resections for benign and malignant diseases, such as choledochal cysts, postcholecystectomy bile ducts injuries, and periampullary carcinoma 2, 3.
The hepaticojejunostomy technique with intraanastomotic. Sep 19, 2017 laparoscopic roux en y hepaticojejunostomy for postcholecystectomy benign biliary stricture with aberrant right anterior duct. Rouxeny hepaticojejunostomy with subcutaneous access and the use of. Robotassisted complete excision of choledochal cyst type i. The current standard treatment of choice for choledochal cyst is complete excision with rouxeny hepaticojejunostomy due to possible associated complications if left untreated, such as cholangitis, pancreatitis, cirrhosis, portal. Longterm followup of 120 patients after hepaticojejunostomy. Gastric bypass, also called roux en y roo en wy gastric bypass, is a type of weightloss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. It has been performed laparoscopically with the advancement of laparoscopic skill.
Indications for hepaticojejunostomy in 1 patients no. The literature on patients undergoing br after rygb is very limited. External metallic circle in hepaticojejunostomy bmc. This medical exhibit shows several images related to rouxeny hepaticojejunostomy. Objective the aim of this study was to evaluate factors affecting the operating time for complete cyst excision and roux en y hepaticojejunostomy in paediatric cases of congenital choledochal malformation ccm. The surgical appro ach was a complete extrahepatic cyst excision with rouxeny hepaticojejunostomy. Longterm biliary function after reconstruction of major bile.
Robotic left hepatectomy and rouxeny hepaticojejunostomy. Indisputable tenets of this procedure include the creation of a durable jejunojejunostomy, followed by the creation of a tensionfree anastomosis between the hepatic duct and the defunctionalized jejunal limb. May 30, 2019 bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. Roux en y hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal representative of biliary diversion procedures. Hepaticojejunostomy hj rouxeny is the preferred method of surgical treatment of most of major bdi. We found 1 possible way to abbreviate rouxeny hepaticojejunostomy. Choledochoscopic highfrequency needleknife electrotomy. The creation of a rouxeny ry hepaticojejunostomy hj is a critical. Rouxeny biliary reconstruction david lee joohyun kim definition rouxeny hepaticojejunostomy ryh was described by cesar roux in 1926 to reconstruct drainage of the esophagus following a total gastrectomy.
Rouxeny hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal. All chole dochal cysts associated to biliary atresia or. In rouxeny gastric bypass surgery, the surgeon fashions an alternate eggsized pouch, which is joined with the small intestine, so food skips the upper stomach and goes straight to the pouch. The surgery limits the amount of food the stomach can hold. A distance of 40 cm will be measured distal to the efferent cut end and the afferent limb will be anastomosed at this point. The roux limb will be created by dividing the jejunum about 1520 cm downstream from the ligament of trietz. For choledochal cyst type i, complete excision of cyst with roux en y hepaticojejunostomy anastomosis is the treatment of choice. We report on a patient here with acute kidney disease due to calcium oxalate nephropathy, rather than the conditions mentioned above. Calcium oxalate nephropathy is rare in current practice. Surgery department, university of antioquia school of medicine.
In very high strictures and in reinterventions anastomosis between left hepatic duct and roux en y jejunal limb was carried out. Eusguided hepaticojejunostomy with transjejunal peroral cholangioscopy and electrohydraulic lithotripsy in a patient with complicated choledocholithiasis after rouxeny gastric bypass videogie. This video presents a robotic left hepatectomy and roux en y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. Comparing with open procedure, laparoscopic procedure has zhe wen and huiying liang have contributed equally to this paper. This configuration of the intestines has been applied for biliary reconstruction following bile duct excision. Roux en y hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries. With the growing population of patients who have had rygb, it may be anticipated that a surgeon who performs br will at some point encounter this altered anatomy. The surgical appro ach was a complete extrahepatic cyst excision with rouxen y hepaticojejunostomy. In general surgery, a roux en y anastomosis, or roux en y, is an endtoside surgical anastomosis of bowel used to reconstruct the gastrointestinal tract.
Eusguided hepaticojejunostomy with transjejunal peroral. Totally laparoscopic management of choledochal cyst. It may be performed as a palliative bypass procedure. Y hepaticojejunostomy in patients with primary sclerosing cholangitis who had undergone liver transplant in shiraz organ transplant center.
The biliary reconstruction of transected bile ducts type e injuries was performed by an endtoside rouxeny hepaticojejunostomy according to the heppcouinaud technique. Hepaticojejunostomy using shortlimb rouxeny reconstruction. Rouxeny laparoscopic pancreaticojejunostomy for chronic pancreatitis juan toro, md, jesus vasquez, md, carlos lopera, md, sergio diaz, md, jean vergnaud, md, andres ricardo. I had an open roux en y hepaticojejunostomy 7 weeks ago. Rouxeny hepaticojejunostomy or choledochojejunostomy biliary enteric anastomosis is performed for selected cases of biliary stricture, bile duct injury, or bile duct tumor. Hepaticojejunostomy for the management of sump syndrome arising from choledochoduodenostomy in a patient who underwent bariatric roux en y gastric bypass. Hepaticojejunostomy with external metallic circle were performed in eight male spraguedawley rats.
The creation of a rouxeny ry hepaticojejunostomy hj is a critical component of many types of hepatobiliary operations. Laparoscopic rouxeny hepaticojejunostomy for benign biliary. Biliary ascariasis after rouxeny hepaticojejunostomy. Laparoscopic surgery comprising excision of the extrahepatic bile duct and wide rouxeny hepaticojejunostomy with ductoplasty was performed by using four trocars.
Factors affecting the operating time for complete cyst. It was a common complication during jejunoileal bypass, but much less seen in modern gastric bypass surgery for morbid obesity. Joseph espat, in blumgarts surgery of the liver, biliary tract and pancreas, 2volume set sixth edition, 2017. The goal of surgical repair of the bdi is to restore the continuity of the injured bile duct. In general surgery, a rouxeny anastomosis, or rouxeny, is an endtoside surgical anastomosis of bowel used to reconstruct the gastrointestinal tract. A rouxeny say rooenwhy gastric bypass is surgery to make the stomach smaller and change the connection between the stomach and the intestines.
Pdf the need to control recurrent biliary strictures implies the practice of repeated. Rouxeny hepaticojejunostomy ryhj is the most common form of reconstruction of the biliary pathway. Biliary reconstruction in liver transplant patients with. Roux en y laparoscopic pancreaticojejunostomy for chronic pancreatitis juan toro, md, jesus vasquez, md, carlos lopera, md, sergio diaz, md, jean vergnaud, md, andres ricardo. The sidetoside roux en y hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel. The results of the longterm followup of 202 patients with rouxeny hepaticojejunostomy rouxeny hj and 19 with hepaticojejunoduodenostomy hjd are reported. Roux en y hepaticojejunostomy ryhj is the most common form of reconstruction of the biliary pathway. Typically, it is between stomach and small bowel that is distal or further down the gastrointestinal tract from the cut end. A 52yearold man underwent laparoscopic cholecystectomy at another institution 8.
A distal jejunal loop of approximately 10,0 to 15,0 cm must be kept far from the anastomosis that allows its setting, without tension, in the anterior gastric wall bellow the small bending, between body and of the stomach antrum. A roux en y say roo en why gastric bypass is surgery to make the stomach smaller and change the connection between the stomach and the intestines. Biliaryenteric anastomosis especially rouxen y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. Robotassisted repair of e1 biliary ductal injury with roux. It is a time honoured, durable, less resource intensive and a defi nitive procedure. Design retrospective analysis of consecutive patients requiring biliary enteric reconstructions from february 1, 1993, through january 1, 2002, for bile duct injuries. At the end of the third month, anastomoses were analysed for. The objective of this study is to compare operative time, hospital stay, morbidity leak, cholangitis, ileus, and obstruction, and mortality between hj and hd. Hd has been suggested to be a more physiologic alternative during reconstruction.
The doctor will create tiny incisions in the stomach with the help of a laparoscope, or guided camera that transmits images to a monitor so the entire. If you want to know more about this weight loss surgery, you need to follow this article. This stoma provides permanent access to the biliary. Choledochoscopic highfrequency needleknife electrotomy for.
The most popular abbreviation for roux en y hepaticojejunostomy is. This medical exhibit shows several images related to roux en y hepaticojejunostomy. Laparoscopic rouxeny hepaticojejunostomy for postcholecystectomy benign biliary stricture with aberrant right anterior duct. Biliary reconstruction options for bile duct stricture in. Many studies have reported the shortterm outcome following hj with complications rate reaching up to 2040%. May 12, 2011 four patients 1 ic and 3 iva cysts had hepatic duct stricture around the hepatic hilum. Pdf biliary ascariasis after rouxeny hepaticojejunostomy. Robotassisted repair of e1 biliary ductal injury with. Objective hepaticojejunostomy hj and hepaticoduodenostomy hd are commonly used biliary reconstruction techniques after choledochal cyst excision.
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