Journal de gastroentérologie clinique et d'hépatologie Libre accès

Abstrait

Use of a Subaponeurotic loop for biliary access for endoscopic percutaneous dilation of hepaticojejunostomy stenosis.

Ivette Santillán Lomelí

Roux en Y hepaticojejunostomy continues to be the gold standard procedure for the reconstruction of bile duct injury. Despite good surgical technique, there are still postoperatory conditions that are inevitable: intrahepatic stones, reflux cholangitis and stenosis of the anastomosis. The incidence of stenosis has a rate of 6.87% at 2-13 years after the surgery and a prevalence up to 25%. This condition brings significant complications like: biliary cirrhosis, portal hypertension, recurrent cholangitis and hepatic failure. Treatment options are: percutaneous intervention, enteroscopy and surgical treatment. In our team, we have approximately 100 minimal invasive reconstructions of bile duct injury where, as a routine, we leave the blind biliary loop fixated underneath the aponeurosis in subxiphoid region, in order to gain additional access to the hepaticojejunostomy by percutaneos endoscopy if it becomes necessary. The aim of this presentation is to share our experience using this subaponeurotic loop for the endoscopic treatment of stenosis of hepaticojejunostomy in patients with previous bile duct reconstruction.