Reoperation related to Roux-en-Y jejunal limb after hepaticojejunostomy of choledochal cyst.

OBJECTIVE

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.

METHOD

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.

RESULT

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.

CONCLUSION

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.