Stricture post Hepatico-Jejenostomy. Radiological and Endoscopic Management.

Abstract

Introduction: The Roux-en-Y hepatico-jejunostomy (HJ)is the main and commonest approach in reconstruction of the biliary system after its injury. Stricture formation may be complicating this procedure, which can lead to multiple hospitalizations and procedures for management. Management options involve interventional radiology via percutaneous transhepatic drainage (PTD), endoscopic procedures or reoperation of the biliary tract.

Patients and methods: This study was carried out between May 2010 and December 2018 on 18 patients complaining from post HJ stricture. Patients divided into two groups: Group A percutaneous trans-hepatic approach done for 11 patients. Group B included 7 patients with access loop technique, endoscopic approach done for them.

Results: This study included 18 patients (15 females (83.3%) and 3 males (16.7%)) with mean ages of (32.09±8.96) and (36.42±7.06) of group A and B respectively. Success rate in Group A was (81.8%) in 9 patients, while failure rate was (18.2%) in 2 patients which necessitates redo of HJ. While success rate in Group B was (85.7%) in 6 patients, and failure rate was (14.3%) in 1 patient. Also HJ was done for this patient.

Conclusion: Minimally invasive procedures for post HJ biliary stricture either percutaneous or endoscopic via access loop must be considered as the first line of management.