Modified "Roux en Y" hepaticojejunostomy to permit transgastric endoscopic access.

PURPOSE To present an option technique during the accomplishment of a "Roux-en-Y" hepaticojejunostomy that, allows future transgastric endoscopic access to the biloenteric anastomosis. METHODS The side-to-side "Roux-en-Y" hepaticojejunostomy is carried through transmesocolic, retrogastric short tunnel. A distal jejunal loop of approximately 10,0 to 15,0 cm must be kept far from the anastomosis that allows its setting, without tension, in the anterior gastric wall bellow the small bending, between body and of the stomach antrum. Once the jejunal segment is fixed on the anterior gastric wall, this will allow future endoscopic access to the bilioenteric anastomosis, carried through transgastric punction guided by endoscopic-ultrasound (EUS). CONCLUSION The modified "Roux en Y" hepaticojejunostomy is a simple and new technique to permit an alternative transgastric endoscopic access to bilioenteric anastomosis.

[1]  C. Wilcox,et al.  Endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy. , 2010, Gastroenterology clinics of North America.

[2]  E. Parlak,et al.  Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy , 2010, Surgical Endoscopy.

[3]  B. Jabłońska,et al.  Hepaticojejunostomy vs. End-to-end Biliary Reconstructions in the Treatment of Iatrogenic Bile Duct Injuries , 2009, Journal of Gastrointestinal Surgery.

[4]  R. Walsh,et al.  Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. , 2007, Surgery.

[5]  M. Talamini,et al.  Surgical Management of Bile Duct Injuries Sustained During Laparoscopic Cholecystectomy: Perioperative Results in 200 Patients , 2005, Annals of surgery.

[6]  J. Hunter,et al.  Ten-year trend in the national volume of bile duct injuries requiring operative repair , 2005, Surgical Endoscopy And Other Interventional Techniques.

[7]  K. Ludwig,et al.  Value and Consequences of Routine Intraoperative Cholangiography During Cholecystectomy , 2002, Surgical laparoscopy, endoscopy & percutaneous techniques.

[8]  M. Talamini,et al.  Postoperative Bile Duct Strictures: Management and Outcome in the 1990s , 2000, Annals of surgery.

[9]  Y. Jan,et al.  Percutaneous transhepatic biliary drainage for acute cholangitis. , 1987, International surgery.

[10]  I. Hawkins,et al.  The Treatment of Acute Cholangitis: Percutaneous Transhepatic Biliary Drainage Before Definitive Therapy , 1987, Annals of surgery.

[11]  W. Hogan,et al.  Endoscopic access to the papilla of Vater. , 1980, Endoscopy.