Laparoendoscopic approach for refractory Roux‐en‐Y hepaticojejunostomy stricture in an acute setting: A unique case and technique

• Published in: Asian journal of endoscopic surgery Vol. 7; no. 1; pp. 67 - 70
• Main Authors: Pidigue, Rajan Seshiyer, Chinnusamy, Palanivelu, Jategaonkar, Priyadarshan Anand, Ramakrishnan, Parthasarathi, Subbiah, Rajapandian, Palanisamy, Senthilnathan, Natesan, Anand Vijai S, Palanivelu, Praveen Raj
• Format: Journal Article
• Language: English
• Published: Japan 01.01.2014
• Subjects: Anastomosis, Roux-en-Y; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Female; Hepaticojejunostomy stricture; hepatolithiasis; Humans; Jejunum - surgery; laparoendoscopic surgery; Laparoscopy - methods; Liver - surgery; Middle Aged; Postoperative Complications - surgery; Recurrence; Hepaticojejunostomy stricture; hepatolithiasis; laparoendoscopic surgery
• ISSN: 1758-5902; 1758-5910
• DOI: 10.1111/ases.12065

Roux‐en‐Y hepaticojejunostomy stricture is a substantial problem that develops in 10%–30% of patients and requires frequent intervention. Although endoscopic/percutaneous approaches are preferred, especially for refractory stricture, open surgical reconstruction remains the gold standard. However, such an operation may be highly challenging. The recently developed covered, self‐expanding metallic stent is a useful option for such difficult cases. We present a case of recurrent Roux‐en‐Y hepaticojejunostomy stricture complicated by densely packed intrahepatic stones and suppurative cholangitis with failed percutaneous biliary draining. Enteroscopic manipulations were unfeasible, and the case was successfully managed by the laparoendoscopic approach. If treating surgeons have the necessary expertise, this technique may be considered in such difficult scenarios.