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Raafat M, Morsy MM, Mohamed SI, Hamad MA, Sayed MM. Therapeutic Role of Subcutaneous Access Loop Created Adjunct to Hepaticojejunostomy for Management of Bile Duct Injury. Am Surg 2023; 89:5711-5719. [PMID: 37142256 DOI: 10.1177/00031348231173945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Roux-en-Y hepaticojejunostomy (RYHJ) is usually required for major bile duct injury (BDI) as a definitive treatment. Hepaticojejunostomy anastomotic stricture (HJAS) is the most feared long-term complication following RYHJ. The ideal management of HJAS remains undefined. The provision of permanent endoscopic access to the bilio-enteric anastomotic site can make endoscopic management of HJAS feasible and attractive option. In this cohort study, we aimed to evaluate short- and long-term outcomes of subcutaneous access loop created adjunct to RYHJ (RYHJ-SA) for management of BDI and its usefulness for endoscopic management of anastomotic stricture if occurred. MATERIALS AND METHODS This is a prospective study including patients who were diagnosed with iatrogenic BDI and underwent hepaticojejunostomy with subcutaneous access loop between September 2017 and September 2019. RESULTS This study included a total number of 21 patients whom ages ranged between 18 and 68 years. During follow-up, three cases had HJAS. One patient had the access loop in subcutaneous position. Endoscopy was done but failed to dilate the stricture. The other 2 patients had the access loop in subfascial position. Endoscopy of them failed to enter the access loop due to failure of fluoroscopy to identify the access loop. The three cases underwent redo-hepaticojejunostomy. Parajejunal (parastomal) hernia occurs in 2 patients in whom the access loop was fixed subcutaneous position. CONCLUSION In conclusion, modified RYHJ with subcutaneous access loop (RYHJ-SA) is associated with reduced quality of life and patient satisfaction. Moreover, its role in endoscopic management of HJAS after biliary reconstruction for major BDI is limited.
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Affiliation(s)
- Mohamad Raafat
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Morsy M Morsy
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Salah I Mohamed
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Mostafa A Hamad
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Mostafa M Sayed
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
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Raafat M, Morsy MM, Mohamed SI, Hamad MA, Sayed MM. Hepaticojejunostomy with gastric access loop versus conventional hepaticojejunostomy: a randomized trial. Updates Surg 2023; 75:2157-2167. [PMID: 37556078 PMCID: PMC10710387 DOI: 10.1007/s13304-023-01604-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
Roux-en-Y hepaticojejunostomy (RYHJ) with the provision of "gastric access loop" was developed to shorten the distance traveled by the endoscope to reach hepaticojejunostomy (HJ) anastomotic site. The aim of our study was to assess modified RYHJ with gastric access loop (RYHJ-GA) and compare it with conventional RYHJ (RYHJ-C) regarding short- and long-term outcomes and, moreover, to evaluate the feasibility and results of future endoscopic access of the modified bilio-enteric anastomosis. Patients eligible for RYHJ between September 2017 and December 2019 were allocated randomly to receive either RYHJ-C or RYHJ-GA. Fifty-two patients were randomly assigned to RYHJ-C (n = 26) or RYHJ-GA (n = 26). Three cases in RYHJ-C and 4 cases in RYHJ- GA developed HJ anastomotic stricture (HJAS) (P=0.68). 3 cases of RYHJ-GA had successful endoscopic dilation and balloon sweeping of biliary mud (one case) or stones (2 cases). Revisional surgery was needed in 2 cases of RYHJ-C and 1 case in RYHJ-GA (P=0.68). Modified RYHJ with gastric access loop is comparable to the classic hepaticojejunostomy regarding complications. However, gastric access enables easy endoscopic access for the management of future HJAS. This modification should be considered in patients with a high risk of HJAS during long-term follow-up.The trial registration number (TRN) and date of registration:ClinicalTrials.gov (NCT03252379), August 17, 2017.
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Affiliation(s)
- Mohamad Raafat
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt.
| | - Morsy M Morsy
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
| | - Salah I Mohamed
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
| | - Mostafa A Hamad
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
| | - Mostafa M Sayed
- Department of General Surgery, Faculty of Medicine, Assiut University, 10 Building W, Assiut University Campus, Asyut, 71515, Egypt
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Donatelli G, Cereatti F, Spota A, Danan D, Tuszynski T, Dumont JL, Derhy S. Long-term placement of lumen-apposing metal stent after endoscopic ultrasound-guided duodeno- and jejunojejunal anastomosis for direct access to excluded jejunal limb. Endoscopy 2021; 53:293-297. [PMID: 32767287 DOI: 10.1055/a-1223-2302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Management of biliary disorders in patients with altered anatomy may be challenging. Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis using a lumen-apposing metal stent (LAMS) was introduced to allow endoscopic retrograde cholangiography (ERC) in such cases. However, the appropriate stent indwelling time remains uncertain. We report long-term LAMS deployment after duodenojejunal or jejunojejunal anastomosis (EUS-DJA) to allow endoscopic reinterventions in cases of recurrences. METHODS 11 consecutive patients underwent EUS-DJA with long-standing LAMS between January 2017 and December 2018. Over a 12-month period, ERC treatment was carried out with multiple endoscopic sessions across the DJA. RESULTS Technical success was 91 % (10/11) for EUS-DJA and 100 % for ERC. Four patients presented stricture recurrence at a mean of 489 days (standard deviation [SD] 31.7) after the end of ERC treatment. A novel ERC across the LAMS anastomosis was feasible in all cases. At a mean of 781 days (SD 253.1), all LAMS remained in place with no evidence of complications. CONCLUSION Long-term LAMS placement after EUS-DJA may be feasible and safe for direct access to the excluded limb.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France.,Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France.,Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - David Danan
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Serge Derhy
- Unité de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
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Kaplan M, Dişibeyaz S, Ödemiş B, Parlak E, Öztaş E, Gökbulut V. Endoscopic retrograde cholangiography via a permanent access loop. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:318-323. [PMID: 32412902 DOI: 10.5152/tjg.2020.19229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to investigate the indications, technical and clinical success, and complications of the endoscopic retrograde cholangiography (ERC) via a permanent access loop (PAL). MATERIALS AND METHODS Twenty patients who underwent ERC through PAL between 2009 and 2017 were included in this study. The technical success was described as achieving access to the bile ducts through PAL and the clinical success was described as the clinical and laboratory improvement of the patients after the procedure. RESULTS The study was performed with 20 patients. The median follow-up duration was 24 months (3-96) and the median number of ERC sessions was 3.9 (1-10). The most common ERC indications through PAL were stones (40%) and cholangitis (30%). In 16 patients (75%), anastomotic or branched strictures were observed. The improvement of strictures via intermittent stenting and dilatation was observed in 6 patients, but no improvement was observed in 5 patients. The treatment of those 5 patients continues. In this study, the technical success was 100% and clinical success was 85%. While no mortality due to PAL-mediated ERC was observed, free wall perforation was seen in one patient who was referred to surgery. CONCLUSION PAL-mediated ERC procedure is a technique with high technical and clinical success and low complication rate in patients who require frequent percutaneous procedures and those with difficult access to the biliary tract.
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Affiliation(s)
- Mustafa Kaplan
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Selçuk Dişibeyaz
- Department of Gastroenterology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Bülent Ödemiş
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Hacettepe University School of Medicine Ankara, Turkey
| | - Erkin Öztaş
- Department of Gastroenterology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Volkan Gökbulut
- Department of Gastroenterology, Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Endoscopic treatment of biliary stones in patients with liver transplantation. Surg Endosc 2016; 31:1327-1335. [DOI: 10.1007/s00464-016-5116-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/12/2016] [Indexed: 01/26/2023]
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Enestvedt BK, Kothari S, Pannala R, Yang J, Fujii-Lau LL, Hwang JH, Konda V, Manfredi M, Maple JT, Murad FM, Woods KL, Banerjee S. Devices and techniques for ERCP in the surgically altered GI tract. Gastrointest Endosc 2016; 83:1061-75. [PMID: 27103361 DOI: 10.1016/j.gie.2016.03.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 02/08/2023]
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Jiang O, Zhou RX, Yang K, Cai CX, Liu Y, Cheng NS. Negative short-term impact of intraoperative biliary lavage in patients with hepatolithiasis. World J Gastroenterol 2016; 22:3234-3241. [PMID: 27004001 PMCID: PMC4789999 DOI: 10.3748/wjg.v22.i11.3234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/27/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate short-term outcomes following intraoperative biliary lavage for hepatolithiasis.
METHODS: A total of 932 patients who were admitted to the West China Medical Center of Sichuan University between January 2010 and January 2014 and underwent bile duct exploration and lithotomy were retrospectively included in our study. The patients were divided into the lavage group and the control group. Related pre-, intra-, and postoperative factors were recorded, analyzed, and compared between the two groups in order to verify the effects of biliary lavage on the short-term outcome of patients with hepatolithiasis.
RESULTS: Amongst the patients who were included, 678 patients with hepatolithiasis were included in the lavage group, and the other 254 patients were enrolled in the control group. Data analyses revealed that preoperative baseline and related intraoperative variables were not significantly different. However, patients who underwent intraoperative biliary lavage had prolonged postoperative hospital stays (6.67 d vs 7.82 d, P = 0.024), higher hospitalization fees (RMB 28437.1 vs RMB 32264.2, P = 0.043), higher positive rates of bacterial cultures from blood (13.3% vs 25.8%, P = 0.001) and bile (23.6% vs 40.7%, P = 0.001) samples, and increased usage of advanced antibiotics (26.3% vs 38.2%, P = 0.001). In addition, in the lavage group, more patients had fever (> 37.5 °C, 81.4% vs 91.1%, P = 0.001) and hyperthermia (> 38.5°C，39.7% vs 54.9%, P = 0.001), and higher white blood cell counts within 7 d after the operation compared to the control group.
CONCLUSION: Intraoperative biliary lavage might increase the risk of postoperative infection, while not significantly increasing gallstone removal rate.
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Bhandari S, Bathini R, Sharma A, Maydeo A. Percutaneous endoscopic management of intrahepatic stones in patients with altered biliary anatomy: A case series. Indian J Gastroenterol 2016; 35:143-146. [PMID: 27041379 DOI: 10.1007/s12664-016-0636-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/07/2016] [Indexed: 02/08/2023]
Abstract
Incidence of primary intrahepatic stones (IHS) in India is very less as compared to the Far East. However patients with altered biliary anatomy are prone for IHS formation secondary to anastomotic stricture formation. Indian data on percutaneous endoscopic management of IHS is scare. Five patients with IHS were managed percutaneously. All patients had undergone Roux-en-Y hepaticojejunostomy and were not suitable for direct endoscopic intervention. All patients underwent percutaneous biliary drainage followed by cholangioscopy-guided laser lithotripsy. Crushed stones were pushed across the anastomotic site using basket/balloon and ductal clearance was achieved. Good stone pulverization could be achieved in five patients (100 %). Complete ductal clearance could be achieved in all patients (100 %). Cholangioscopy-guided treatment of IHS can be valuable alternative to surgery in select group of patients especially those having dilated biliary tree with absence of intrahepatic strictures. However long-term follow up studies are required to see for recurrence of stone formation.
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Affiliation(s)
- Suryaprakash Bhandari
- Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India.
| | - Rajesh Bathini
- Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India
| | - Atul Sharma
- Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India
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Results of endoscopic treatment for the management of stenotic end-to-side hepaticoduodenostomy. Surg Laparosc Endosc Percutan Tech 2014; 24:502-5. [PMID: 24710249 DOI: 10.1097/sle.0b013e3182937bb2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The outcome of endoscopic treatment for the management of surgical end-to-side hepaticoduodenostomy (HD) has not been extensively studied. The aim of this study was to evaluate the results of endoscopic management of HD. METHODS The medical records of 17 patients with HD stenosis who were referred to the ERCP unit between August 2003 and June 2012 for endoscopic intervention were retrospectively analyzed. RESULTS Fourteen patients presented with cholangitis, of whom, jaundice was the presenting complaint in 3 patients. Eight patients (47.1%) who had stents placed for a median of 2 (min, 1; max, 3) ERCP periods remained asymptomatic for a median stent-free period of 19.5 months (min, 7; max, 96 mo). Five patients (29.4%) who had stents placed for a median of 2 (min, 1; max, 5) ERCP periods presented with an episode of stone-related cholangitis for a mean of 41.8±28.9 months after stent removal. These 5 patients remained asymptomatic for a median of 9.5 months (min, 5; max, 40 mo) after endoscopic stone extraction. Three patients with HD (17.6%) were followed up with stents for 4 to 19 ERC periods. One HD patient (5.9%) who had cholangitis associated with secondary biliary cirrhosis died of cholangitis-related complications, despite the treatment with stents for 4 ERC periods. CONCLUSION Endoscopic management is also a realistic treatment option for stenotic HD anastomosis, although success rates may vary.
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