Roux-en-Y hepatico Jejunostomy versus end-to-end anastomosis for intraoperatively detected bile duct injuries

ABSTRACT

to compare the results of end-to-end anastomosis of common bile duct with T--tube drainage and Roux en-Y hepatico jejunostomy in the management of intra-operatively detected complete transection of common bile duct during cholecystectomy either open or laparoscopic. Prospective, study. Ain Shams University Hospitals and New Jeddah Clinic Hospitals. Sixteen patients with complete transection of C.B.D., divided into two groups. Eight patients managed by end-to-end anastomosis of C.B.D "group A", and eight patients managed by Roux-en-Y. Hepatico-jejunostomy "group B". Operative mortality, post-operative complications, liver function tests, biliary fistula, anastomotic dysfunction and reoperations. No operative mortality occurred. The post operative outcome of both groups were compared. Good long term results were obtained in group B in 87.5%.Early post operative complications and course were comparable in both groups but late stricture and anastomotic dysfunction were more frequent in group A. [37.5%]. Also re-operations were more frequent in groupA [50%]. Good long term results were obtained with Roux-en-y hepatico jejunostomy, it should be the mainstay of management in this context. Although end-to end anastomosis of C.B.D. provides optimal internal biliary drainage with a reasonable chance for cure, yet, it should be a second option in management of intra operatively detected complete transection of C.B.D