Long-Term Changes in Hepatobiliary Physiology After Roux-en-Y Hepaticojejunostomy

Abstract

Hepaticojejunostomy (HJ) is a common operation used to by-pass extrahepatic biliary obstructions and to establish biliary-enteric continuity after resections for benign and malignant diseases. Little is known about the effect of this procedure on hepatobiliary physiology. The aim of the present study was to investigate in a swine model the changes in biliary dynamics, bile composition, and hepatic histology induced by Roux-Y HJ. Twenty-four swine (57 (47 to 76) kg) underwent cholecystectomy, with HJ (Group I; n = 12) or without any biliodigestive anastomosis (Group II, n = 12), and were followed up for 6 or 12 mo by repeated weight scaling, blood, serum, and bile analysis, (99m)Technetium (Tc), diethyliminodiacetic acid (HIDA) dynamic biligraphy, and histological analysis. During follow-up, HJ was associated with less weight gain, colonization of the bile duct with aerobic bacteria Escherichia coli dominating (in 75% of the animals), a shortened hilum-intestine transit time but reduced liver clearance in dynamic biligraphy, and fibrous periportal changes in liver histology (in 50% of the animals). We conclude that during 1 y follow-up HJ with no anastomotic stricture formation is associated with improved extrahepatic bile drainage, but with ascending contamination of bile ducts with bacteria, which might be involved with the fibrous periportal changes in the liver resulting in diminished excretion of Tc-HIDA from the hepatocytes into the bile. The clinical significance of these changes, and the reduced weight gain observed is a topic of further investigations.