Blind subcutaneous jejunal loop for interventional procedures in recurrent benign biliary stricture

Abstract

Most of the benign biliary strictures (BBS) occurs as a result of iatrogenic injury of bile ducts during laparoscopic or open cholecystectomies and can effectively be treated surgically by restoring the bilioenteric continuity. However ; recurrent stenosis, stasis, cholangitis and intrahepatic cholelithiasis continue to be a problem with those patients. Creating a permanent access enables endoscopic and radiological interventions in cases with post operative recurrent benign biliary sticture . We present a 36 year old man who developed reccurrent BBS due to biliary injury during cholecystectomy. He was operated twice previously in different centers . The third operation was performed in our department with an Roux en Y Hepaticojejunostomy. Besides we created a blind, subcutaneously located, isolated isoperistaltic jejunal loop to perform percutaneous and endoscopic therapeutic procedures for the treatment of the recurrent stenosis and obstruction. During the follow up period we used permanent access route four times to open and to enlarge the hepaticojejunostomy side. Now the patient has secondery biliary chirosis and is on the waiting list for liver transplantation and under the control of outpatient clinic.