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. Hepaticojejunostomy hj roux en y is the preferred method of surgical treatment of most of major bdi. Roux en y hepaticojejunostomy ryhj is the most common form of reconstruction of the biliary pathway. Rouxeny biliary reconstruction plastic surgery key. Biliary reconstruction br is commonly performed for benign and malignant diseases of the hepatobiliary system. Calcium oxalate nephropathy is rare in current practice. Laparoscopic rouxeny hepaticojejunostomy for benign biliary. Laparoscopic rouxeny hepaticojejunostomy for benign. The results of the longterm followup of 202 patients with rouxeny hepaticojejunostomy rouxeny hj and 19 with hepaticojejunoduodenostomy hjd are reported.
Rouxeny hepaticojejunostomy with subcutaneous access and the. Using a short enteroscope 152 cm and commercially available endoscopic retrograde cholangiography accessories, biliary interventions were performed in. At the end of the third month, anastomoses were analysed for. Totally laparoscopic management of choledochal cyst.
This medical image is titled rouxeny hepaticojejunostomy exhibit number. After gastric bypass, swallowed food will go into this small pouch of stomach and then directly into the small intestine. This stoma provides permanent access to the biliary. Robotic assisted excision of type i choledochal cyst with. 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. In very high strictures and in reinterventions anastomosis between left hepatic duct and roux en y jejunal limb was carried out. 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. Biliary reconstruction and rouxeny hepaticojejunostomy for the. Choledochoscopic highfrequency needleknife electrotomy for. Treatment of failed rouxeny hepaticojejunostomy after post. A new technique of hepaticojejunostomy is described. Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. Rouxeny hepaticojejunostomy or choledochojejunostomy biliary enteric anastomosis is performed for selected cases of biliary stricture, bile duct injury, or bile duct tumor. The technique involves the incorporation of a cutaneous access stoma in the roux.
For the sake of comparison, patients were divided into 2. Roux en y hepaticojejunostomy ryhj or hepaticodudenostomy hd is the most commonly used techniques for biliary. Biliaryenteric anastomosis especially rouxen y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. The aim of this study was to evaluate the feasibility of short dbe for managing biliary disorders in patients with a roux. Gianturco stents for the management of biliary tract strictures. 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. External metallic circle in hepaticojejunostomy bmc. After completion of the anastomosis, the robotic system was undocked and small upper midline incision was made. Biliary reconstruction options for bile duct stricture in.
Surgical management consisted of a rouxeny hepaticojejunostomy. Primary cyst excision combined with biliary reconstruction is the standard treatment of choledochal cysts. Laparoscopic rouxeny hepaticojejunostomy for postcholecystectomy benign biliary stricture with aberrant right anterior duct. Surgery department, university of antioquia school of medicine. Longterm followup of 120 patients after hepaticojejunostomy. Eusguided hepaticojejunostomy with transjejunal peroral. May 30, 2019 bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. Eusguided hepaticojejunostomy with transjejunal peroral cholangioscopy and electrohydraulic lithotripsy in a patient with complicated choledocholithiasis after roux en y gastric bypass videogie.
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. 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. Design retrospective analysis of consecutive patients requiring biliary enteric reconstructions from february 1, 1993, through january 1, 2002, for bile duct injuries. Management of duct to duct biliary anastomotic stricture with modified roux en y hepaticojejunostomy in. The surgery limits the amount of food the stomach can hold. 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. The sidetoside rouxeny hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel. The operation was completed laparoscopically for all patients. 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. The objective of this study is to compare operative time, hospital stay, morbidity leak, cholangitis, ileus, and obstruction, and mortality between hj and hd.
The hepaticojejunostomy technique with intraanastomotic stent in. 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. Pdf biliary ascariasis after rouxeny hepaticojejunostomy. All chole dochal cysts associated to biliary atresia or.
Especially after roux en y gastric bypass rygb, conventional ercp is rarely successful in patients with symptomatic choledocholithiasis. 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. Roux en y hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries. Eusguided hepaticojejunostomy with transjejunal peroral cholangioscopy and electrohydraulic lithotripsy in a patient with complicated choledocholithiasis after rouxeny gastric bypass videogie. Y hepaticojejunostomy in patients with primary sclerosing cholangitis who had undergone liver transplant in shiraz organ transplant center. The creation of a rouxeny ry hepaticojejunostomy hj is a critical component of many types of hepatobiliary operations. Rouxeny hepaticojejunostomy with subcutaneous access and the use of. A surgical procedure which may be done for severe obesity.
Rouxeny hepaticojejunostomy technique is a commonly performed during biliary reconstruction. Biliaryenteric anastomosis especially roux en y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. This medical exhibit shows several images related to rouxeny hepaticojejunostomy. The mortality, morbidity, and the incidence of postoperative anastomotic stenosis were comparable in both groups. Unfortunately he suffered a right hepatic artery rha injury along with a transection of his common bile duct. 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. It may be performed as a palliative bypass procedure. Choledochoscopic highfrequency needleknife electrotomy.
Design a 3year retrospective study was undertaken between january 20 and december 2015 in four centres in china. No intra or perioperative complications of the surgery were noted. Total cyst excision and rouxeny hepaticojejunostomy is the standard procedure for choledochal cyst 4. Mar 29, 2017 calcium oxalate nephropathy is rare in current practice. A rouxeny say rooenwhy gastric bypass is surgery to make the stomach smaller and change the connection between the stomach and the intestines. 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. Rouxeny hepaticojejunostomy ryhj is the most common form of reconstruction of the biliary pathway. For choledochal cyst type i, complete excision of cyst with roux en y hepaticojejunostomy anastomosis is the treatment of choice.
We found 1 possible way to abbreviate rouxeny hepaticojejunostomy. In the setting of liver transplantation, the ryh is an. 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. Initially, a ptcd and balloon dilation of the stricture should be performed, as it is a simple and effective procedure. 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. Rouxeny hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal. A reappraisal of its indications and results article pdf available in annals of surgery 1812. 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. Typically, it is between stomach and small bowel that is distal or further down the gastrointestinal tract from the cut end. My fiance had a lapo gallbladder procedure a year ago.
Hepaticojejunostomy for the management of sump syndrome arising from choledochoduodenostomy in a patient who underwent bariatric roux en y gastric bypass. 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. This technique has met many milestones of extensive evolution, particularly the last years of concomitant technological evolution laparoscopicrobotic approach. We present a case of early robotassisted repair of a strasberg class e 1 bile duct injury with rouxeny hepaticojejunostomy. May 12, 2011 four patients 1 ic and 3 iva cysts had hepatic duct stricture around the hepatic hilum. Pdf the need to control recurrent biliary strictures implies the practice of repeated. This video presents a robotic left hepatectomy and roux en y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. If you want to know more about this weight loss surgery, you need to follow this article. The sidetoside roux en y hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel. The results achieved with this technique, which was performed in 26 patients, were about the same following hepaticojejunostomy. 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. I had an open roux en y hepaticojejunostomy 7 weeks ago. 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. This medical image is titled roux en y hepaticojejunostomy exhibit number.
The roux limb will be created by dividing the jejunum about 1520 cm downstream from the ligament of trietz. Total console time of 4 hours with minimal blood loss and no requirement for transfusion with length of stay of 3 days. Robotassisted complete excision of choledochal cyst type i. Sep 19, 2017 laparoscopic roux en y hepaticojejunostomy for postcholecystectomy benign biliary stricture with aberrant right anterior duct. It has been performed laparoscopically with the advancement of laparoscopic skill. A 52yearold man underwent laparoscopic cholecystectomy at another institution 8. Hypothesis normal biliary function can be achieved after reconstruction for major bile duct injuries using either hepaticoduodenostomy hd or roux en y hepaticojejunostomy hj. Recently, a telemanipulative robotic surgical system was introduced, providing laparoscopic instruments with wristarm technology and 3dimensional visualization of the operative. A distance of 40 cm will be measured distal to the efferent cut end and the afferent limb will be anastomosed at this point. Biliary reconstruction and rouxeny hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury. 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. Laparoscopic surgery comprising excision of the extrahepatic bile duct and wide rouxeny hepaticojejunostomy with ductoplasty was performed by using four trocars. In general surgery, a rouxeny anastomosis, or rouxeny, is an endtoside surgical anastomosis of bowel used to reconstruct the gastrointestinal tract. Comparing with open procedure, laparoscopic procedure has zhe wen and huiying liang have contributed equally to this paper.
The surgical appro ach was a complete extrahepatic cyst excision with rouxeny hepaticojejunostomy. 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. This medical exhibit shows several images related to roux en y hepaticojejunostomy. Pdf rouxeny hepaticojejunostomy with subcutaneous access. For choledochal cyst type i, complete excision of cyst with rouxeny hepaticojejunostomy anastomosis is the treatment of choice. 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.
The goal of surgical repair of the bdi is to restore the continuity of the injured bile duct. Choledochal cyst is a relatively rare congenital disease. Hepaticojejunostomy with external metallic circle were performed in eight male spraguedawley rats. 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. This chapter lists the indications, essential steps, common technical variations, and complications of the procedure. Multiple studies examining the longterm outcome of biliary. Hepaticojejunostomy using shortlimb rouxeny reconstruction. 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. D biliary reconstruction, and 260 patients had a roux. Anastomotic stricture is a complex and substantial complication following rouxeny hepaticojejunostomy.
We report on a patient here with acute kidney disease due to calcium oxalate nephropathy, rather than the conditions mentioned above. Rouxeny hepaticojejunostomy ryhj is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal representative of biliary diversion procedures. Four patients 1 ic and 3 iva cysts had hepatic duct stricture around the hepatic hilum. Longterm results of rouxeny hepaticojejunostomy and. Choledochojejunostomy an overview sciencedirect topics. Robotic left hepatectomy and rouxeny hepaticojejunostomy. Longterm biliary function after reconstruction of major. Joseph espat, in blumgarts surgery of the liver, biliary tract and pancreas, 2volume set sixth edition, 2017. This video presents a robotic left hepatectomy and rouxeny hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. We present a case of early robotassisted repair of a strasberg class e 1 bile duct injury with roux en y hepaticojejunostomy. Purchase the right to use this exhibit in litigation. Roux en y hepaticojejunostomy or choledochojejunostomy biliary enteric anastomosis is performed for selected cases of biliary stricture, bile duct injury, or bile duct tumor.
The creation of a rouxeny ry hepaticojejunostomy hj is a critical. 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. Biliary reconstruction in liver transplant patients with. Many studies have reported the shortterm outcome following hj. Get a printable copy pdf file of the complete article 2.
View the article pdf and any associated supplements and figures for a period of 48 hours. The creation of a roux en y ry hepaticojejunostomy hj is a critical component of many types of hepatobiliary operations. 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. Excision of choledochal cyst in children by rouxeny. 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. Hd has been suggested to be a more physiologic alternative during reconstruction.
However, the use of available endoscopic retrograde cholangiography accessories during this procedure is limited because of the length of the conventional instrument 200 cm. The literature on patients undergoing br after rygb is very limited. Rouxeny hepaticojejunostomy ryhj is currently con sidered as the definitive treatment for iatrogenic bile duct injuries 1. Robotassisted complete excision of choledochal cyst type.
Robotassisted repair of e1 biliary ductal injury with. In this study, we present the results of hepaticojejunostomy with external metallic circle. Robotassisted repair of e1 biliary ductal injury with roux. 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. A 52yearold man underwent laparoscopic cholecystectomy at. The types are divided based on the procedures of the surgery. Rouxeny laparoscopic pancreaticojejunostomy for chronic pancreatitis juan toro, md, jesus vasquez, md, carlos lopera, md, sergio diaz, md, jean vergnaud, md, andres ricardo. 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. Hepaticojejunostomy hj rouxeny is the preferred method of surgical treatment of most of major bdi. Hepaticojejunostomy complications gallbladder community oct 16, 2016 hi.
Especially after rouxeny gastric bypass rygb, conventional ercp is rarely successful in patients with symptomatic choledocholithiasis. The hepaticojejunostomy technique with intraanastomotic. The surgical appro ach was a complete extrahepatic cyst excision with rouxen y hepaticojejunostomy. Biliary ascariasis after rouxeny hepaticojejunostomy by l. Laparoscopic surgery comprising excision of the extrahepatic bile duct and wide roux en y hepaticojejunostomy with ductoplasty was performed by using four trocars. The most popular abbreviation for roux en y hepaticojejunostomy is.
Rouxeny hepaticojejunostomy or choledochojejunostomy. 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. Sidetoside enteroenterostomy anastomosis was created outside abdominal cavity. A rouxeny loop of at least 40 cm length was used carefully. This configuration of the intestines has been applied for biliary reconstruction following bile duct excision. Objective hepaticojejunostomy hj and hepaticoduodenostomy hd are commonly used biliary reconstruction techniques after choledochal cyst excision. Biliary ascariasis after rouxeny hepaticojejunostomy. Longterm biliary function after reconstruction of major bile. It is a time honoured, durable, less resource intensive and a defi nitive procedure.
634 1040 1231 299 207 280 1189 1043 279 260 337 1197 964 1129 60 1191 853 1371 1422 710 204 979 313 432 162 114 981 600 1039 220 1334 280 578 405 906 118 869 509 102 1121 1090 105 648 986 724 323 733