Ming Anxiao, Shao Yifeng, Diao Mei, Li Qi, Li Xu, Li Long
Department of Pediatric Surgery, Capital Institute of Pediatrics; Research Unit of Minimally Invasive Pediatric Surgery On Diagnosis and Treatment, Chinese Academy of Medical Sciences (2021RU015), Beijing, 100020, China.
Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Pediatr Surg Int. 2025 Jun 12;41(1):167. doi: 10.1007/s00383-025-06056-0.
To summarize the case data of reoperations related to the Roux-en-Y jejunal limb following hepaticojejunostomy for choledochal cysts at our center, aiming to provide insights into the prevention of adverse events.
A retrospective analysis was conducted on five cases from April 2019 to October 2024 at our center, in which reoperations were required due to errors in the Roux-en-Y jejunal limb following hepaticojejunostomy for choledochal cysts. Among the patients, four were female, and one was male. Three cases presented with recurrent cholangitis and intestinal dilatation, while two cases involved Roux-en-Y jejunal limb necrosis and bile leakage. All patients underwent laparotomy for exploration. Surgical outcomes, operation times, and treatment approaches were summarized, and the duration of hospitalization and postoperative outcomes were also analyzed.
In three cases with recurrent cholangitis, intraoperative exploration revealed a misconnection in the Roux-en-Y anastomosis, due to the formation of a jejunal limb from the elevated proximal jejunum. Corrective Roux-en-Y hepaticojejunostomy was then performed. Symptoms such as cholangitis and intestinal dilation were completely alleviated postoperatively. In two cases with bile leakage, necrotic jejunal limbs were resected, followed by corrective Roux-en-Y hepaticojejunostomy. After reoperation, the bile leakage was resolved, and infection indicators returned to normal. The average postoperative hospital stay was 10.5 ± 5.5 days (range: 5-21 days), with a median follow-up of 12 months (range: 2-53 months). Follow-up results indicated that the patients were in good general condition, with no abnormalities in liver function tests, and no elevation of infection markers detected during follow-up.
Reoperations due to technical errors or necrosis in Roux-en-Y jejunal limbs are uncommon, the complications caused by the Roux-en-Y jejunal limbs can be very severe and even life-threatening. Early diagnosis and timely surgical intervention can effectively relieve symptoms and reduce patient suffering. Preventive measures should be prioritized since adherence to standard procedures can help prevent these complications.
总结我院中心胆管囊肿肝空肠吻合术后与Roux-en-Y空肠袢相关的再次手术病例资料，旨在为预防不良事件提供见解。
对我院中心2019年4月至2024年10月期间的5例病例进行回顾性分析，这些病例因胆管囊肿肝空肠吻合术后Roux-en-Y空肠袢出现失误而需要再次手术。患者中4例为女性，1例为男性。3例表现为复发性胆管炎和肠扩张，2例涉及Roux-en-Y空肠袢坏死和胆漏。所有患者均接受剖腹探查术。总结手术结果、手术时间和治疗方法，并分析住院时间和术后结果。
3例复发性胆管炎患者术中探查发现Roux-en-Y吻合口连接错误，原因是高位空肠近端形成空肠袢。随后进行了纠正性Roux-en-Y肝空肠吻合术。术后胆管炎和肠扩张等症状完全缓解。2例胆漏患者切除坏死的空肠袢，随后进行纠正性Roux-en-Y肝空肠吻合术。再次手术后，胆漏得到解决，感染指标恢复正常。术后平均住院时间为10.5±5.5天（范围：5 - 21天），中位随访时间为12个月（范围：2 - 53个月）。随访结果表明，患者一般状况良好，肝功能检查无异常，随访期间未检测到感染指标升高。
因Roux-en-Y空肠袢技术失误或坏死导致的再次手术并不常见，Roux-en-Y空肠袢引起的并发症可能非常严重甚至危及生命。早期诊断和及时的手术干预可以有效缓解症状，减轻患者痛苦。应优先采取预防措施，因为严格遵守标准程序有助于预防这些并发症。
