Abstract
Roux-en-Y hepaticojejunostomy is the procedure of choice in the management of patients with major bile duct injuries. In instances of anastomotic stricture, this anastomosis is inaccessible to conventional endoscopy. A technique is described for assessment and intervention of bilioenteric anastomoses that escape the reach of conventional endoscopy. Three cases are presented illustrating the feasibility of open and laparoscopic-assisted small-bowel endoscopy. All patients presented with recurrent cholangitis and had multiple interventions in their biliary tree prior to referral. At operation, the limb of jejunum going to the bilioenteric anastomosis was identified, an enterotomy was made, and a flexible endoscope was passed to evaluate the anastomosis. In two cases the anastomosis was revised by endoscopically excising scar tissue. In the third case the anastomosis was patent and unnecessary intervention was avoided. There was no morbidity or mortality and the patients had complete resolution of their symptoms. Operative endoscopy appears to be useful in the evaluation and intervention of bilioenteric anastomoses that cannot be evaluated by conventional endoscopy.
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References
Asbun HJ, Rossi RL (1994) Techniques in laparoscopic cholecystectomy: the difficult operation. Surg Clin North Am 74(4): 755–775
Asbun HJ, Rossi RL, Lowell JA, Munson JL (1993) Bile duct injury during laparoscopic cholecystectomy: mechanisms of injury, prevention and management. World J Surg 17: 547–552
Berkelhammer C, Kortan P, Haber GB (1989) Endoscopic biliary prostheses as treatment for benign postoperative bile duct strictures. Gastrointest Endosc 35: 95–101
Dawson SL, Mue6ller PR (1994) Interventional radiology in the management of bile duct injuries. Surg Clin North Am 74(4): 865–874
Desa LA, Ohri SK, Hutton KAR, Lee H, Spencer J (1991) Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel origin. Br J Surg 78: 192–195
Hutson DG, Russell E, Schiff E, Levi JJ, Jeffers L, Zeppa R (1984) Balloon dilatation of biliary strictures through a choledochojejuno-cutaneous fistula. Ann Surg 199(6): 637–647
Kozicki I, Bielecki K, Kawalski A, Krolicki L (1994) Repeated reconstruction for recurrent benign bile duct stricture. Br J Surg 81(5): 677–679
Kremer B, Henne-Bruns D, Grimm H, Soehendra N (1989) Bilio-duodenal jejunum interposition as a technical alternative to Roux-Y reconstruction following reconstruction of cancer of the fork of the hepatic duct. Chirurg 67(9): 599–602
Lau WY (1990) Intraoperative enteroscopy—indications and limitations. Gastrointest Endosc 36: 268–271
Lewis BS, Wenger JS, Waye JD (1991) Small bowel enteros-copy and intraoperative enteroscopy for obscure gastrointestinal bleeding. Ital J Gastroenterol 25: 68–716
Monprofit MA (1908) Du remplacement du cholédoque et l'hépatique par une ans6e ejunale. Cong Franc Chir 21: 206–209
O'Connell H, Martin CJ (1992) Intra-operative enteroscopy in the management of bleeding small bowel lesions. Aust NZ J Surg 62: 394–396
Pellegrini CA, Thomas MJ, Way LW (1984) Recurrent biliary stricture. Patterns of recurrence and outcome of surgical therapy. Am J Surg 147(1): 175–180
Phillips E, Hakim MH, Saxe A (1994) Laparoendoscopy (laparoscopy assisted enteroscopy) and partial resection of small bowel. Surg Endosc 8: 686–688
Quintero GA, Espinosa H, Pineres G, Ariza A, Zundel N, Botero R, Cuervo H, Ucros G, Patino JF (1992) Roux-en-Y hepaticojejunostomy with subcutaneous access and the use of Gianturco stents for the management of biliary tract strictures. World J Surg 16(6): 1178–1181
Ress AM, Benacci JC, Sarr MG (1992) Efficacy of intraoperative enteroscopy in diagnosis and prevention of recurrent, occult gastrointestinal bleeding. Am J Surg 163: 94–99
Rossi R, Asbun H, Martin RF, Heiss FW, Shea JA, Velez P (in press) The use of expandable stents for benign bile duct strictures. Gastrointest Endosc
Rossi RL, Taso J (1994) Biliary reconstruction. Surg Clin North Am 74(4): 825–841
Sachse RE, Hutson DG, Russell E, Levi JJ, Schiff E (1990) Hepaticojejunostomy with a subcutaneous blind jejunum segment. An alternative in the treatment of stenosing bile duct diseases. Chirurg 61(5): 402–406
Schweizer WP, Matthews JB, Baer HU, Nudelmann LI, Triller J, Halter F, Gertsch P, Blumgart LH (1991) Combined surgical and interventional radiological approach for complex benign biliary tract obstruction. Br J Surg 78(5): 559–563
Smedh K, Olaison G, Nystrom PO, Sjodahl R (1993) Intraoperative enteroscopy in Crohn's disease. Br J Surg 80: 897–900
Takehara H, Okada A, Nishi M, Masamune K, Komi N (1992) Intra-operative total enteroscopy for the management of Peutz-Jegher's syndrome. Acta Paediatr Jpn 34: 569–572
Vogel SB, Howard RJ, Caridi J, Hawkins IF Jr (1985) Evaluation of percutaneous transhepatic balloon dilatation of benign biliary strictures in high-risk patients. Am J Surg 149(1): 73–79
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Asbun, H.J., Villa-Gomez, G., Foianini, J. et al. Operative enteroscopy. Surg Endosc 9, 1093–1095 (1995). https://doi.org/10.1007/BF00188994
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DOI: https://doi.org/10.1007/BF00188994