Introduction
choledochal cysts, benign biliary strictures, iatrogenic bile duct injury, Hepaticojejunostomy anastomotic stricture, biliary tract tumors
DILATION, SEQUELAE, COMPLICATION
Roux-en-Y hepaticojejunostomy (RYHJ) is the standard procedure used by most hepatobiliary surgeons for biliary reconstruction during surgical management of iatrogenic bile duct injury, benign biliary strictures, choledochal cysts and biliary tract tumors. Hepaticojejunostomy anastomotic stricture (HJAS) is the most serious long-term complication due to its devastating sequelae [Although HJAS can be treated in selected cases by interventional radiology with percutaneous transhepatic balloon dilation, or endoscopically using a long enteroscope, the performance of a new biliary-enteric anastomosis is the most widely used therapeutic option [Despite the high efficacy of endoscopic management of HJAS via either balloon dilatation or stenting, the endoscopic access to the anastomotic site is hampered by the long distance traveled by the endoscope in the jejunal loop to reach the bilio-enteric anastomosis. This can be overcome if a short “access loop” to bilio-enteric anastomotic site is available. The provision of gastric access loop adjunct to RYHJ may facilitate endoscopic intervention by allowing bile duct cannulation via a short gastro-jejunal pathway [The aim of our study was to assess modified RYHJ with gastric access loop (RYHJ-GA) and compare it with conventional RYHJ (RYHJ-C) regarding short- and long-term outcomes and, moreover, to evaluate the feasibility and results of future endoscopic access of the modified bilio-enteric anastomosis.