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Open AccessCase Report

Transjejunal Laparoscopic Assisted ERCP in a Patient with Roux-en-Y Hepaticojejunostomy

1
Escuela Nacional de Medicina, Tecnologico de Monterrey, Monterrey 64710, Mexico
2
Hospital Regional ISSSTE Monterrey, Monterrey 66603, Mexico
3
Escuela Nacional de Ingeniería, Tecnologico de Monterrey, Monterrey 64849, Mexico
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(8), 483; https://doi.org/10.3390/medicina55080483
Received: 1 July 2019 / Revised: 8 August 2019 / Accepted: 11 August 2019 / Published: 14 August 2019
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Abstract

Background and Objectives: Nowadays, with the increasing laparoscopic expertise and accessibility to modern surgical tools, laparoscopic assisted ERCP (LAERCP) has become an effective approach for the management of bile stone disease in patients with modified gastrointestinal anatomy. In contrast to patients with gastric bypass in whom a transgastric LAERCP approach is usually performed, the resultant anatomy of Roux-en-Y hepaticojejunostomy precludes a gastric approach as the newly formed bilioenteric anastomosis is not reachable through the stomach. Therefore, a transjejunal approach has been described as an alternative LAERCP technique. To the best of our knowledge this is the tenth case of transjejunal LAERCP reported worldwide. Materials and Methods: We present the case of a 50-year-old female with history of biliary injury during a cholecystectomy corrected with Roux-en-Y hepaticojejunostomy who presented to our center with manifestations of acute abdomen. After laboratory and image analysis, diagnosis of intrahepatic lithiasis was confirmed. The decision to perform a transjejunal LAERCP was made due to the complex anatomy in this patient. No complications were found during surgery and in the follow up period. Conclusions: Transjejunal LAERCP is an effective approach for endoscopic management of biliary complications in patients with Roux-en-Y hepaticojejunostomy and other modified gastrointestinal anatomy. Previous recommendations by more experienced teams have been reported, nonetheless, there are too few cases reported to make definitive recommendations and conclusions. In limited settings, such as ours, some of these recommendations may not be applicable. We are certain that, with the increasing expertise and innovations in laparoscopy surgery for the management of complications that cannot be addressed by endoscopic or noninvasive measures, more cases will be reported. View Full-Text
Keywords: Roux-en-Y hepaticojejunostomy; hepaticojejunal anastomosis; endoscopic retrograde cholangiopancreatography; hepatic cholelithiasis; biliary injury repair Roux-en-Y hepaticojejunostomy; hepaticojejunal anastomosis; endoscopic retrograde cholangiopancreatography; hepatic cholelithiasis; biliary injury repair
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Baca-Arzaga, A.A.; Navarro-Chavez, H.; Galindo-Jimenez, J.; Santibanez-Juarez, J.; Cardosa-Gonzalez, C.; Flores-Villalba, E. Transjejunal Laparoscopic Assisted ERCP in a Patient with Roux-en-Y Hepaticojejunostomy. Medicina 2019, 55, 483.

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