Project description:Congenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation.

| S-EPMC4942164 | biostudies-literature

EUS-directed transenteric ERCP–assisted internalization of a percutaneous biliary drain in Roux-en-Y anatomy

Project description:Video Video 1 EUS-directed transenteric ERCP–assisted internalization of percutaneous biliary drain in Roux-en-Y hepaticojejunostomy anatomy.

| S-EPMC9552021 | biostudies-literature

Advanced Roux-en-Y hepaticojejunostomy with magnetic compressive anastomats in obstructive jaundice dog models.

Project description:BackgroundAlthough commonly used procedure, Roux-en-Y hepaticojejunostomy (RYHJ) remains to be complicated, time consuming, and has a relatively poor prognosis. We designed the magnetic compressive anastomats (MCAs) to perform RYHJ more efficiently and safely.Materials and methods36 dogs were divided into two groups randomly. After obstructive jaundice model construction, RYHJ was performed with MCAs in study group or by hand-sewn in control group. Both groups were followed for 1, 3, and 6 months after RYHJ. The liver function and postoperative complications were recorded throughout the follow-up. At the end of each time point, dogs were sent for magnetic resonance imaging (MRI) and sacrificed. Anastomotic samples were taken for anastomotic narrowing rate calculation, histological analyses, tensile strength testing, and hydroxyproline content testing.ResultsThe anastomotic construction times were 44.20 ± 23.02 min in study group, compared of 60.53 ± 11.89 min in control group (p < 0.05). The liver function recovered gradually after RYHJ in both groups (p > 0.05). All anastomats were expelled out of the body in 8.81 ± 2.01 days. The gross incidence of morbidity and mortality was 33.3% (6/18) and 16.7% (3/18) in study group compared with 38.9% (7/18) and 22.2% (4/18) in control group (p > 0.05), and there is no single case of anastomotic-specific complications happened in study group. The narrowing rates of anastomosis were 14.6, 18.5, and 18.7% in study group compared with 35.4, 36.9, and 34% in control group at 1st, 3rd, and 6th month after RYHJ (p < 0.05). In study group, preciser alignment of tissue layers and milder inflammatory reaction contributed to the fast and better wound healing process.ConclusionPerform RYHJ with MCAs is safer, more efficient than by hand-sewn method in obstructive jaundice dog models.

| S-EPMC5772124 | biostudies-literature

Novel technique using pancreatic duct stent facilitates difficult biliary cannulation in patients with Roux-en-Y anatomy (with video).

Project description:Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy has been reported to be useful. However, selective biliary cannulation through the papilla is difficult in cases with surgically altered gastrointestinal anatomy. Herein, we report a successful biliary cannulation using a pancreatic duct (PD) stent in patients with Roux-en-Y anatomy. A 70-year-old man who underwent total gastrectomy with Roux-en-Y anatomy was admitted to our hospital with jaundice due to recurrence of gastric cancer. ERCP was performed for biliary drainage. We approached the papilla using a short-type single-balloon enteroscope (SIF-H290; Olympus Medical Systems). Because the papilla was positioned tangentially, it was difficult to adjust the catheter in the direction of the bile duct. As only a PD could be cannulated, we placed a guidewire in the PD. Although we attempted the double-guidewire technique using a guidewire placed in PD, selective biliary cannulation was difficult. Therefore, we placed a PD stent 5Fr-5cm (Geenen, Pancreatic Stent Sets, Cook Medical, Bloomington, IN, USA) to assist biliary cannulation. We inserted a catheter crossing the PD stent. With this, selective biliary cannulation was successful. We successfully performed selective biliary cannulation using the PD stent as we were able to fix the papilla, straighten the common channel and the axis of the bile duct, and not restrict scope movement by not using the PD guidewire placement method. This novel technique using a PD stent appears to be useful in patients with surgically altered gastrointestinal anatomy.

| S-EPMC7144784 | biostudies-literature

Open injury, robotic repair-moving ahead! Total robotic Roux-en-Y hepaticojejunostomy for post-open cholecystectomy Bismuth type 2 biliary stricture using indocyanine green dye.

Project description:Hepaticojejunostomy is currently the best treatment for post-cholecystectomy biliary strictures. Laparoscopic repair has not gained popularity due to difficult reconstruction. We present case of 43-year-old-female with Bismuth type 2 stricture following laparoscopic converted open cholecystectomy with bile duct injury done elsewhere. Position was modified Llyod-Davis position and four 8-mm robotic ports (including camera) and 12-mm assistant port were placed. The procedure included noticeable steps such as adhesiolysis, identification of gallbladder fossa, identification of common hepatic duct, lowering of hilar plate etc. Operating and console time were 420 and 350 minutes and blood loss was 100 mL. Patient was discharged on postoperative day 4. Robotic repair (hepaticojejunostomy) of biliary tract stricture after cholecystectomy is safe and feasible with good outcomes.

| S-EPMC10505368 | biostudies-literature

Pancreatogenic choledocholithiasis in common bile duct stump after Roux-en-Y hepaticojejunostomy: A case report.

Project description:Choledocholithiasis in common bile duct (CBD) stump after Roux-en-Y hepaticojejunostomy (RYHJ) is incredibly rare and its pathophysiology is poorly understood.A 79-year-old woman was admitted to our hospital with upper abdominal pain radiating through to the back in November 2016.Abdominal computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed filling defects in CBD stump, chronic pancreatitis, and dilatation of CBD stump and main pancreatic duct (MPD).During the endoscopic retrograde cholangiopancreatography (ERCP), cannulation proceeded easily from MPD to CBD through a variant pancreatic duct, and then white crushed stones extracted from the CBD stump. Elemental analysis and infrared spectrophotometry demonstrated that the main constituent of the calculi was calcium carbonate.After a therapeutic ERCP, the patient's symptoms disappeared, and a 9-month follow-up indicated no remaining stones or lithiasis relapse.This type of choledocholithiasis in CBD stump after RYHJ has never been reported before. We nominated it as "pancreatogenic choledocholithiasis," and pancreatobiliary reflux caused by a variant pancreatic duct may be the main cause.

| S-EPMC5704883 | biostudies-other

Management of combined malignant biliary-duodenal obstruction in Roux-en-Y gastric bypass anatomy with EUS-guided gastrogastrostomy, EUS biliary drainage, and duodenal stent placement.

Project description:Video 1Demonstration of deploying lumen-apposing metal stents for gastrogastrostomy and choledochoduodenostomy in a patient with Roux-en-Y gastric bypass anatomy, as well as EUS-guided fine needle biopsy for pancreatic mass.

| S-EPMC8186001 | biostudies-literature

EUS-guided hepaticogastrostomy for management of cholangitis, hepatolithiasis, and anastomotic stricture after Roux-en-Y hepaticojejunostomy.

Project description:Video 1EUS-guided hepaticogastrostomy for management of cholangitis, hepatolithiasis, and anastomotic stricture after Roux-en-Y hepaticojejunostomy.

| S-EPMC8117964 | biostudies-literature

EUS-guided hepaticogastrostomy to facilitate cholangioscopy and electrohydraulic lithotripsy of massive intraductal stones after Roux-en-Y hepaticojejunostomy.

Project description: Not available

| S-EPMC7482416 | biostudies-literature