Biliary stricture after Roux-en-Y hepaticojejunostomy for bile duct injury–surgical challenge: a single-center expertise

Abstract

Background Laparoscopic cholecystectomy has been considered the gold standard since the 1990. Yet the incidence of bile duct injury (BDI) has increased from 0.06 to 0.3% for open cholecystectomy to 0.5 to 1.4% when done laparoscopically. Roux-en-Y hepaticojejunostomy (RYHJ) is the most widely approved management for most post-cholecystectomy BDIs, yet some patients experience incapacitating biliary complications, such as jaundice or recurrent attacks of cholangitis, in addition to anastomotic stricture. Aim The aim of this study was to assess the short-term outcomes of a multidisciplinary approach regarding failed RYHJ after post-cholecystectomy BDI. Materials and methods A total of 15 patients were enrolled in the descriptive study after failure of RYHJ performed because of post-cholecystectomy BDI. Patients comprised six males and nine females. All patients after definitive treatment underwent follow-up by abdominal ultrasound and liver function tests for at least 11 months. Results One (6.7%) patient had liver transplantation because of liver cirrhosis. Four (26.7%) other cases were managed by revisionary surgery for the hepaticojejunostomy as the stricture was so tight. The reminder 10 cases underwent trial of percutaneous trans-hepatic cholangiography (PTC), but unfortunately six of them (40% of the whole group) failed to be dilated adequately, and they indeed underwent surgery, and the other four (26.7%) were dilated successful. During the follow-up, three (20%) patients had biliary leakage and two patients developed re-stricture, with one mortality because of pulmonary embolism. Conclusion Good long-term results can be achieved in patients with RYHJ stricture through a case-by-case analysis and an immediate multidisciplinary approach in expert hepatobiliary center.