Application of marking and fixation of jejunal loop combined with transjejunal choledochoscopy in managing complications after cholangiojejunostomy
10.3760/cma.j.cn113884-20250207-00040
- VernacularTitle:空肠盲袢标记固定联合胆道镜在胆肠吻合术后并发症处理中的应用研究
- Author:
Huanye LIU
1
;
Ziyu ZHANG
1
;
Haitao SUN
1
;
Wei HAN
1
Author Information
1. 首都医科大学附属北京潞河医院普外科，北京 101100
- Publication Type:Journal Article
- Keywords:
Anastomosis, Roux-en-Y;
Biliary tract diseases;
Gallstone;
Blind loop
- From:
Chinese Journal of Hepatobiliary Surgery
2025;31(5):341-345
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the transjejunal choledochoscopy via a marked and fixed jejunal loop in the management of anastomotic complications after choledochojejunostomy.Methods:Clinical data of 17 patients undergoing choledochoscopy exploration and treatment via a subcutaneous jejunal loop at Beijing Luhe Hospital, Capital Medical University from January 2014 to August 2023 were retrospectively analyzed, including 5 males and 12 females, with a median age of 57 years (24-69 years). All patients had a jejunal loop marked and fixed subcutaneous during previouse Roux-en-Y choledochojejunostomy or biliary anastomotic reconstruction surgery. Choledochoscopy was performed via the pre-fixed loop to manage biliary strictures and stones. Baseline and perioperative date including gender, age, primary disease, jejunal loop puncture and catheterization, choledochoscopy exploration and operative time and frequency, and postoperative complications (bleeding, bile leakage, infection, etc.) were recorded.Results:The primary diseases of the 17 patients included nine cases of congenital choledochal cysts, three cases of common bile duct stones, three cases of common bile duct strictures, one case of intrahepatic and extrahepatic bile duct stones, and one case of gallbladder cancer. Eight patients had their jejunal loop drainage tubes removed or only had subcutaneous marking and fixation without T-tube placement. A total of 12 attempts were made to puncture and catheterize via the jejunal loop under X-ray guidance, with 11 successful punctures. Choledochoscopy exploration or operation was performed 67 times via the jejunal loop in 17 patients, all successfully reaching the biliary-enteric anastomosis. Intrahepatic cholangiolithiasis were found during 28 choledochoscopy explorations via the jejunal loop, with stones directly removed using a stone basket in 25 cases and electrohydraulic lithotripsy in three cases. Biliary-enteric anastomotic or intrahepatic bile duct strictures were found in 34 choledochoscopy explorations via the jejunal loop, with 22 cases undergoing balloon dilation. Among them, 14 cases had biliary strictures combined with stones, and the stones were removed after balloon dilation of the strictures. Other choledochoscopy explorations showed no abnormalities. The operative time of 67 choledochoscopy explorations via the jejunal loop was (67±42) min, with no intraoperative complications. Two cases had postoperative drainage tube displacement and dislocation, which were repositioned through the sinus tract immediately, and no complications such as bleeding, bile leakage, or infection occurred.Conclusion:Pre-fixation of the jejunal loop during choledochojejunostomy offers a minimally invasive access for postoperative choledochoscopy that could directly reach the biliary-enteric anastomosis, and effectively manage the long-term biliary-enteric anastomotic complications, including biliary strictures and cholangiolithiasis.
