Outcomes of revisional surgery for stenosed hepaticojejunostomy procedures

Although hepaticojejunostomy provides durable and efficient access for bilioenteric continuity, it is not free from complications, as stenosis could occur in 25% of cases. Radiologically guided interventions are the best options for managing stenosed anastomoses. However, about 30% of stenosed patients show failure. Thus, surgical intervention (redo) is a must in such circumstances. Herein, we describe the outcomes of redo surgery for patients diagnosed with stenosed hepaticojejunostomy after failed radiological interventions. During the study period, we encountered 52 patients with stenosed hepaticojejunostomy, from whom 20 cases showed failed radiological intervention, and they were enrolled in our study, and their data were collected and retrospectively reviewed. The primary procedure was performed for cholecystectomy-related biliary injury (80%), choledochal cyst (15%), and as a step of the Whipple procedure (5%). All patients presented with jaundice, while 25% of them had cholangitis. Radiological assessment showed Bismuth class I, II, III, and IV in 20, 45, 25, and 10%, respectively. The time interval between the primary and the redo procedure ranged between 6 months and 5 years. Operative time ranged between 110 and 150 min, and hospital stay ranged between 4 and 10 days. Postoperative complications included bile leakage (5%), pulmonary embolism (5%), wound infection (20%), and incisional hernia (10%). No patients developed restenosis during the follow-up period. History of cholangitis was a significant risk factor for postoperative morbidity. Revisional procedures for stenosed hepaticojejunostomy are considered safe and efficacious. The safety is manifested in the accepted complication rate, while the efficacy is manifested in the excellent success rate. However, it should be preserved only for patients with failed radiological interventions.