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