Laparoscopic Roux-en-Y Hepatico- or Choledocho-jejunostomy in the Era of Laparoscopic Surgery

Background: With rapid development and wide application of laparoscopic procedure in biliary surgery, laparoscopic Roux-en-Y hepatico- or choledo-chojejunostomy is being performed more frequently than ever since our first report on 2004. Method: Between February 1997 and September 2008, 36 patients underwent laparoscopic biliary-enteric anastomosis with the diagnosis of choledochal cyst, recurrent CBD stone, intrahepatic duct stone or bilary stricture. Results: The diagnosis of the patients were choledochal cyst in 23, recurrent CBD stone in 8, intrahepatic duct stone in 2, biliary stricture in 2, and Mirizzi syndrome in 1. The Roux limb was divided with an endo-GIA was brought up in the antecolic method. Hepatico- or choledo-chojejunostomy was performed with intracorporeal suture, and then jejunojejunostomy was done with the endo-GIA. For the patients with choledochal cyst, cyst excision was performed prior to this procedure. The mean operation time were 308.4 minutes. Intraoperative transfusion was needed in one patient 2.8%. The postoperative complication occurred in 5 patients (16.7%), including bile leakage (n=2), aspiration pneumonia (n=1), melena (n=1), intraabominal fluid collection (n=1) and intraabominal bleeding (n=1); one patient with intraabominal bleeding was treated by re-operation and the others were improved by conservative management. The mean postoperative hospital stay was 9.5 days. After a mean follow-up of 17.7 months, 6 patients (16.7%) experienced the anastomotic stricture, which were managed by radiologic intervention in four patients and revision of anastomosis in two patients. Conclusions: Laparoscopic Roux-en-Y hepatico- or choledocho-jejunostomy is a useful option in the treatment for the patients with biliary disease.


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Program Number: P409

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