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  • Title: Outcome of hepaticojejunostomy without access loop for repair of iatrogenic bile duct injury at laparoscopic cholecystectomy.
    Author: Barrow PJ, Siriwardena AK.
    Journal: J Hepatobiliary Pancreat Surg; 2007; 14(4):374-6. PubMed ID: 17653635.
    Abstract:
    BACKGROUND PURPOSE: Roux-en-Y hepaticojejunostomy is the accepted treatment for transectional biliary injury at cholecystectomy. Many authors advocate leaving a long redundant jejunal access loop to facilitate subsequent access. Reasoning that percutaneous access can be achieved transhepatically in patients with stenosis, this study reports the outcome of a policy of biliary repair without the use of a jejunal access loop. METHODS: Eleven patients undergoing biliary reconstruction over a 5-year period constituted the study population. Three (27%) were male, and the median (range) age at injury was 53 (26-75) years. Median delay from injury to repair was 2 (1-48) months. Bismuth stage was: stage I, 4; stage II, 5; and stage III, 2. Four patients had concomitant arterial injury. All underwent surgical repair by Roux-en-Y hepaticojejunostomy without an access loop. RESULTS: The median follow-up was 13 (1-64) months. The principal postoperative complication was a hepatic abscess in one patient. There was one death during follow-up, from acute myeloid leukemia. One patient (9%) with a type III injury presented with a symptomatic recurrent biliary stricture 6 months after repair, and was successfully managed by percutaneous biliary dilatation, using a combination of transhepatic and jejunal loop puncture. CONCLUSIONS: Successful biliary reconstruction can be performed without a routine jejunal access loop.
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