Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass
Introduction. Most surgeons prefer Roux-en-Y hepaticojejunostomy (RYHJ) for biliary reconstruction following a common bile duct (CBD) injury. However, in patients with a Roux-en-Y gastric bypass (RYGB) a RYHJ may be technically challenging and can interfere with bowel physiology induced by RYGB. The...
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Wiley
2014-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2014/938532 |
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| author | Sheraz Yaqub Tom Mala Øystein Mathisen Bjørn Edwin Bjarte Fosby Dag Tallak Kjærsdalen Berntzen Andreas Abildgaard Knut Jørgen Labori |
| author_facet | Sheraz Yaqub Tom Mala Øystein Mathisen Bjørn Edwin Bjarte Fosby Dag Tallak Kjærsdalen Berntzen Andreas Abildgaard Knut Jørgen Labori |
| author_sort | Sheraz Yaqub |
| collection | DOAJ |
| description | Introduction. Most surgeons prefer Roux-en-Y hepaticojejunostomy (RYHJ) for biliary reconstruction following a common bile duct (CBD) injury. However, in patients with a Roux-en-Y gastric bypass (RYGB) a RYHJ may be technically challenging and can interfere with bowel physiology induced by RYGB. The use of a hepaticoduodenostomy (HD) resolves both these issues. Presentation of Case. We present a case of CBD injury during laparoscopic cholecystectomy one year after laparoscopic RYGB for morbid obesity. Due to adhesions and previous surgery with RYGB, we did not want to interfere with the RYGB physiology by anastomosing the CBD to the jejunum or ileum. Succeeding a full Kocher’s maneuver we performed biliary reconstruction by a tension-free end-to-side HD. The postoperative recovery was uneventful and the patient was discharged after eight days. At four-month follow-up, the patient had stable weight and normal laboratory test results. MRCP demonstrated normal intra- and extrahepatic bile ducts with status after HD. Discussion. We propose that HD should be considered in treatment of CBD injury in post-RYGB patients as it may reduce the risk of interfering with the post-RYGB physiology. |
| format | Article |
| id | doaj-art-e4b443e9aa424841b98e3abffa54e0e9 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-e4b443e9aa424841b98e3abffa54e0e92025-02-03T05:45:12ZengWileyCase Reports in Surgery2090-69002090-69192014-01-01201410.1155/2014/938532938532Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric BypassSheraz Yaqub0Tom Mala1Øystein Mathisen2Bjørn Edwin3Bjarte Fosby4Dag Tallak Kjærsdalen Berntzen5Andreas Abildgaard6Knut Jørgen Labori7Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayDepartment of Gastrointestinal Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayDepartment of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayDepartment of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayDepartment of Transplantation Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayDepartment of Radiology, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayDepartment of Radiology, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayDepartment of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0317 Oslo, NorwayIntroduction. Most surgeons prefer Roux-en-Y hepaticojejunostomy (RYHJ) for biliary reconstruction following a common bile duct (CBD) injury. However, in patients with a Roux-en-Y gastric bypass (RYGB) a RYHJ may be technically challenging and can interfere with bowel physiology induced by RYGB. The use of a hepaticoduodenostomy (HD) resolves both these issues. Presentation of Case. We present a case of CBD injury during laparoscopic cholecystectomy one year after laparoscopic RYGB for morbid obesity. Due to adhesions and previous surgery with RYGB, we did not want to interfere with the RYGB physiology by anastomosing the CBD to the jejunum or ileum. Succeeding a full Kocher’s maneuver we performed biliary reconstruction by a tension-free end-to-side HD. The postoperative recovery was uneventful and the patient was discharged after eight days. At four-month follow-up, the patient had stable weight and normal laboratory test results. MRCP demonstrated normal intra- and extrahepatic bile ducts with status after HD. Discussion. We propose that HD should be considered in treatment of CBD injury in post-RYGB patients as it may reduce the risk of interfering with the post-RYGB physiology.http://dx.doi.org/10.1155/2014/938532 |
| spellingShingle | Sheraz Yaqub Tom Mala Øystein Mathisen Bjørn Edwin Bjarte Fosby Dag Tallak Kjærsdalen Berntzen Andreas Abildgaard Knut Jørgen Labori Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass Case Reports in Surgery |
| title | Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass |
| title_full | Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass |
| title_fullStr | Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass |
| title_full_unstemmed | Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass |
| title_short | Management of Injury to the Common Bile Duct in a Patient with Roux-en-Y Gastric Bypass |
| title_sort | management of injury to the common bile duct in a patient with roux en y gastric bypass |
| url | http://dx.doi.org/10.1155/2014/938532 |
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