Long-term surgical outcomes
cholangitis, Dyspepsia, hernia, stricture, failure of anastomotic stricture, biliary pain
STRICTURE, BILIARY PAIN, CHOLANGITIS
Dyspepsia occurred in one patient of RYHJ-C and in two patients of RYHJ-GA that responded well to a short PPI regimen while incisional hernia occurred in 2 patients with RYHJ-C and one patient with RYHJ-GA.In the RYHJ-C group, three cases had definite HJAS presented with attacks of cholangitis, persistent elevation of ALP and mild elevation of bilirubin (Table Follow-up data of patientsIn the RYHJ-GA group, three cases of 26 cases did not undergo the planned postoperative endoscopy due to patient refusal. One of them returned with biliary pain due to HJAS. Endoscopic access to the HJ was successful but the cannulation failed due to too tight stricture with subsequent failure of anastomotic stricture dilatation. Revisional surgery, in the form of excision of stricture and re-anastomosis leaving both GJ and entero-enterostomy intact, was done. Strict follow-up of this patient was done with prophylactic endoscopic dilatation (Fig. Consort flow diagramOf the remaining 23 cases, 20 cases underwent a single endoscopy session and 3 cases needed more than one endoscopy session due to significantly elevated ALP (one asymptomatic case needed another session), and cholangitis (2 cases, one of them needed another 2 sessions), (Table Endoscopic findings of RYHJ-GA casesNumber of endoscopic sessions for every patient1 session2 sessions3 sessionsTotal21212826/28 [93%](1 case cannot see HJ; 1 case failed cannulation due to tight stricture)Bile in stomachScale 0Scale 1Scale 26/28 [21.5%]15/28 [53.5%]7/28 [25%]Endoscopic management of hepaticojejunostomy. Cholangiogram via hepaticojejunostomy. 