Long-term outcome of gastric access loop in hepaticojejunostomy

BACKGROUND:The incidence of hepaticojejunostomy stricture is 4%-10% in experienced centres. Many access loops have been designed and used to facilitate endoscopic intervention for this complication of hepaticojejunostomy. In this study, we investigated the effectiveness and safety of gastric access...

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Bibliographic Details
Published in:Hepatobiliary & pancreatic diseases international 2008-04, Vol.7 (2), p.152-155
Main Authors: Selvakumar, Eswaran, Rajendran, Shanmugasundaram, Balachandar, Tirupporur G, Kannan, Devy Gounder, Jeswanth, Satyanesan, Ravichandran, Palaniappan, Surendran, Rajagopal
Format: Article
Language:English
Subjects:
access
Adolescent
Adult
Anastomosis, Surgical - methods
anastomotic
Bile Duct Diseases - diagnostic imaging
Bile Duct Diseases - etiology
Bile Ducts - injuries
Bile Ducts - surgery
biliary
Biliary Tract Surgical Procedures - methods
Cholangiography
Female
Follow-Up Studies
Hepatic Duct, Common - surgery
hepaticojejunostomy
Humans
Jejunostomy - methods
Length of Stay
loop
Male
Middle Aged
Retrospective Studies
stricture
Time Factors
Treatment Outcome
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Summary:BACKGROUND:The incidence of hepaticojejunostomy stricture is 4%-10% in experienced centres. Many access loops have been designed and used to facilitate endoscopic intervention for this complication of hepaticojejunostomy. In this study, we investigated the effectiveness and safety of gastric access loop. METHODS:A retrospective analysis was conducted on 13 patients who had undergone hepaticojejunostomy with gastric access loop between June 1999 and September 2003. Eleven patients were followed up for a mean period of 51 months (range 20-81 months). Two patients were lost to follow up. RESULTS:On follow-up, 8 patients had patent jejuno- gastrostomy (end to side anastomosis between Roux loop of jejunum and stomach) and hepaticojejunostomy. Three patients developed stricture of jejunogastrostomy at 41 months, 63 months and 81 months of follow-up. Among these 3 patients, one also had hepaticojejunostomy stricture. In the patient with hepaticojejunostomy stricture, dilatation of jejunogastrostomy stricture was attempted but failed. None of the patients had any evidence of bile gastritis/cholangitis. There was no procedure related morbidity/mortality. CONCLUSIONS:Further studies involving large numbers of patients are required before wide application of gastric access loop in hepaticojejunostomy though it is a safer option than percutaneous transhepatic manipulations or revision surgery.
ISSN:1499-3872