Long-term postoperative outcomes of Roux-en-Y cholangiojejunostomy in patients with benign biliary stricture

Abstract

Background Although there are common postoperative complications, Roux-en-Y cholangiojejunostomy is still broadly used as a standard surgical procedure for patients with biliary stricture. This study aimed to explore long-term risk factors of cholangiojejunostomy in patients with biliary stricture who underwent revisional cholangiojejunostomy. Methods Clinical data of 61 patients with biliary stricture undergoing revisional cholangiojejunostomy were retrospectively analyzed. These patients were classified into two groups (patients with traumatic biliary stricture and non-traumatic biliary stricture). Postoperative complications and survival time were successfully followed up. Results Among the patients, 34 underwent revisional cholangiojejunostomy due to traumatic biliary stricture, and 27 underwent revisional cholangiojejunostomy due to non-traumatic biliary surgery. Although there was no statistical difference in most clinical data between two groups, biliary dilation or not during the first surgery, cholelithiasis or not during the first surgery, long-term complications after first surgery, cholelithiasis or not during the second surgery, identifying abnormalities during the second surgery and long-term complications after second surgery were significantly different. All patients were successfully followed up and average follow-up time for patients with traumatic and non-traumatic biliary stricture was (88.44 ± 35.67) months and (69.48 ± 36.61) months respectively. Survival analysis indicated that there was no statistical difference in overall survival between two groups. Additionally, cox proportional hazard analysis demonstrated that first preoperative bilirubin level, short-term complication after first surgery and identifying abnormalities during the second surgery were independent risk factors that may have significant effects on patients' overall survival and long-term prognosis after cholangiojejunostomy. Among the intraoperative abnormal findings, residual lesions after the first operation had significant effects on the patients overall survival in the earlier stage. Relatively, anastomotic stoma stricture and biliary output loop problems had obvious effects on patients' overall survival at later stages. Conclusion First preoperative bilirubin level, short-term complication after first surgery and abnormal findings during the second surgery were independent risk factors of revisional cholangiojejunostomy, which may affect patients' long-term survival. Therefore, surgeons should minimize incidence of postoperative complications through fully evaluating optimal operative time and standardizing surgical procedures.

Relationship between postoperative biliary stricture and clinical characteristics of patients with benign and malignant biliary diseases.

“…Postoperative biliary fistula, fluid accumulation in the operation area, bile duct infection, biliary bleeding, biliary stricture, etc. are common complications, which are related to the hospital stay, survival period and long-term prognosis of patients [ 17 ]. Secondly, the body damage of patients with biliary stricture is long-term and persistent.…”

“…In terms of imaging manifestations, magnetic resonance cholangiopancreatography (MRCP), computed tomography (CT), B-ultrasound, T-tube radiography, choledochoscopy, duodenoscopy and other imaging examinations and endoscopy have played an important role in the diagnosis and differential diagnosis of postoperative biliary stenosis [8][9][10]. Due to the persistence of stenosis, secondary surgery under endoscopy, direct vision or endoscopy is often required, which not only increases the pain of patients, but also wastes medical resources [11,12].…”

Fabrication of 3D printed PCL/PEG artificial bile ducts as supportive scaffolds to promote regeneration of extrahepatic bile ducts in a canine biliary defect model

“…Moreover, extensive research has consistently revealed that chronic inflammatory stimuli can give rise to various detrimental health outcomes, such as anastomosis stenosis, stone formation, and an increased risk of cancer development. 6,7 Preserving the sphincter of Oddi as much as possible to prevent reflux is considered an optimal treatment approach for benign strictures. Therefore, repairing with patches for small injuries and replacing the entire bile duct for large injuries are the easiest and most ideal treatment methods for this problem, which also represents the necessity of biliary surgery research on artificial bile ducts.…”