Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury

Cuendis-Velázquez, Adolfo; Bada-Yllán, Orlando; Trejo-Ávila, Mario; Rosales-Castañeda, Enrique; Rodríguez-Parra, Andrés; Moreno-Ordaz, Alberto; Cárdenas-Lailson, Eduardo; Rojano-Rodríguez, Martín Edgardo; Sanjuan-Martínez, Carlos A.; Moreno-Portillo, Mucio

doi:10.1007/s00423-018-1651-8

Cited by 22 publications

(9 citation statements)

References 27 publications

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“…In 1893, César Roux designed a Roux-en-Y jejunal loop for gastrojejunostomy, later used in CJS to prevent intestinal fluid reflux (15). At present, Roux-en-Y CJS is the most commonly used method for bile duct reconstruction in the clinical setting (16,17). However, regardless of the type of CJS, because of the deprecation of the sphincter of Oddi, the problem of intestinal fluid reflux cannot be solved completely, and repeated cholangitis stimulation will cause scar tissue hyperplasia and eventually lead to anastomotic stricture, and even cancer (18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Lyu¹,

Wang²,

Zhou³

et al. 2021

Ann Transl Med

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Background:The present study aimed to analyze the scar formation mechanism following Roux-en-Y choledochojejunostomy (CJS) in a novel rat model of obstructive jaundice. Methods:The biliary obstruction model of Sprague-Dawley (SD) rats was established in advance, and 24 rats were randomly divided into 4 groups (control group, 1-day ligation group, 3-day ligation group, and 5-day ligation group). Changes in postoperative weight, common bile duct diameter, and laboratory indexes were analyzed to determine the best operation time. Roux-en-Y CJS in rats was studied based on the model, and the rats were randomly divided into 4 groups [control group, 3-day choledochojejunostomy (CJS) group, 7-day CJS group, and 30-day CJS group]. The same indexes were analyzed, and the characteristics of scar formation were evaluated by histopathology and polymerase chain reaction examination.Results: The third day after common bile duct ligation is the best time for a Roux-en-Y CJS. The common bile duct diameter expands to 4.2 mm on average, and these physiological characteristics are consistent with current standard clinical findings. After completing CJS, the rats' weight returned to normal levels, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), direct bilirubin (DB), and C-reactive protein (CRP) indexes gradually decreased (P<0.05). Anastomotic stoma diameter tended to narrow with time and was significantly narrower on day 30 than preoperation. After CJS, the expression of α-smooth muscle actin (α-SMA) peaked in the early stage and was still higher than that of the control group in the bile duct wall 1 month postoperatively (P<0.05). Transforming growth factor-β1 (TGF-β1) expression gradually increased and was higher than that of the control group at each stage postoperatively (P<0.05). Conclusions:The rat Roux-en-Y CJS model is more in line with our surgical model, and the clinical condition has potential applicability for the study of CJS scar formation. Scar formation following CJS in rats is characterized by the activation of fibroblasts caused by early inflammatory stimulation, which leads to the proliferation of collagen and smooth muscle fibers, resulting in scars.

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Section: Discussionmentioning

confidence: 99%

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Lyu¹,

Wang²,

Zhou³

et al. 2021

Ann Transl Med

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“…It has been proven to be a safe technique by several groups and outcomes are comparable to open surgery. 1,4,8,9 Kadaba et al 10 reported a series of four hundred and sixty-two open biliary-enteric anastomoses performed for a variety of indications. They concluded that biliary reconstruction following biliary injury and an anastomosis above the confluence were the only significant independent risk factors for anastomotic leak.…”

Section: Discussionmentioning

confidence: 99%

Robotic hepaticojejunostomy: surgical technique and risk factor analysis for anastomotic leak and stenosis

Bustos

Fernandes

Mangano

et al. 2020

HPB

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Background: A variety of techniques have been described for the construction of the HJ (hepaticojejunostomy). Due to its technical challenges, HJ is rarely performed in a pure laparoscopic setting. In stark contrast, the increasing availability of the robotic platform has sparked new interest in pursuing this procedure in a minimally invasive fashion. The aim of our study was to describe our surgical technique and to identify risk factors for anastomotic leak and stenosis following robotic surgery. Methods: We performed a retrospective analysis of a prospectively collected database, including all consecutive HJ carried out for different indications over a 10 year period.Results: One hundred fifty-two patients undergoing robotic HJ performed by the same surgeon were analyzed. Bile leak occurred in 2.6% of the patients. Stricture rate was 3.3%. The median follow up was 25.5 months. There was no mortality related to anastomotic complications. On univariate analysis, patient's age less than 65 years was the only risk factor for anastomotic stricture. On multivariate analysis, no predictor factors for leak or stenosis were identified. Conclusion:HJs carried out in a robotic fashion allow highly satisfactory results. No independent risk factors for bile leak of stenosis were identified on multivariate analysis.

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“…These advantages of the robotic platform allow more precise dissection and suturing in narrow spaces which in theory would be especially useful for complex biliary surgery in the hepatic hilar region. 8,9,[26][27][28][29][30] In the present study, we report our initial experience with our first 27 consecutive RBS and our first 18 consecutive robotically constructed bilio-enteric anastomosis. 21 However, to date studies specifically reporting on RBS remain very limited worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…These advantages of the robotic platform allow more precise dissection and suturing in narrow spaces which in theory would be especially useful for complex biliary surgery in the hepatic hilar region. 24,25 Hence, robotic biliary surgery (RBS) has been adopted by several expert centres as an alternative MIS approach for major biliary procedures such as for hepaticojejunostomies, 8,9,23 repair of bile duct injuries 26 and resections for gallbladder cancer. 21 However, to date studies specifically reporting on RBS remain very limited worldwide.…”

Section: Introductionmentioning

confidence: 99%

Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast Asia

Goh

Low

Teo

et al. 2019

ANZ Journal of Surgery

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Background: Presently, experience with robotic biliary surgery (RBS) is increasing worldwide although widespread adoption remains limited. In this study, we report our initial experience with RBS. Methods: Retrospective review of a single institution prospective database of 95 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2018. Of these, 27 patients who underwent RBS were included in this study. RBS was performed by three principal console surgeons of whom one surgeon performed 23 (85%) and supervised all cases. Additionally, to evaluate our initial outcomes with bilio-enteric anastomoses, eight consecutive pancreatoduodenectomies were included. Results: Of the 27 RBS performed, these included 10 hepaticojejunostomies with bile duct resections (including two concomitant pancreatoduodenectomies and one right hepatectomy) for choledochal cysts, bile duct strictures and biliary malignancies; five liver resections with hilar lymph node clearance for gallbladder cancer; four for Mirizzi syndrome; two cholecystectomies with cholecystoenteric fistula and two bile duct exploration after failed endoscopic treatment of choledocholithiasis. There were no open conversions, no 90-day mortality and four (14.8%) major (>Grade II) morbidities. The median postoperative stay was 6 (range 1-29) days and there was one (3.7%) 30-day readmissions. Of our first 18 robotically constructed bilio-enteric anastomoses, there was only one (5.5%) early anastomotic complication (bile leak requiring reoperation). Conclusion: Our initial experience demonstrated that RBS can be adopted safely with a low open conversion rate. Robotically constructed bilio-enteric anastomosis can be performed safely with a low anastomotic complication rate.

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Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury

Cited by 22 publications

References 27 publications

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice

Robotic hepaticojejunostomy: surgical technique and risk factor analysis for anastomotic leak and stenosis

Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast Asia

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