# Long-Term Evaluation of Roux-en-Y Hepaticojejunostomy in Benign Biliary Diseases: A Retrospective Single-Center Study

## TL;DR

This study evaluates long-term outcomes of a surgical procedure for benign biliary diseases, finding that bile duct injury patients face higher risks of complications like anastomotic stricture.

## Contribution

The study identifies postoperative bile leakage and cholangitis as key predictors of late complications after Roux-en-Y hepaticojejunostomy in benign biliary disease patients.

## Key findings

- Recurrent cholangitis occurred in 39% of patients, and anastomotic stricture in 20%.
- Bile duct injury patients had the highest stricture rates.
- Bile leakage and early cholangitis strongly predicted anastomotic stricture formation.

## Abstract

Introduction: Roux-en-Y hepaticojejunostomy is the standard procedure for restoring biliary-enteric continuity in benign biliary diseases, including choledochal cysts, post-cholecystectomy bile duct injuries, oriental cholangiohepatitis, and benign strictures. This retrospective study aimed to evaluate the long-term outcomes of Roux-en-Y hepaticojejunostomy performed for various benign biliary diseases, with particular emphasis on the incidence, timing, risk factors, and management of late complications, primarily anastomotic stricture and recurrent cholangitis.

Materials and Methods: This single-center retrospective study analyzed 100 consecutive patients who underwent Roux-en-Y hepaticojejunostomy for benign biliary disease between January 2015 and March 2022. Data were retrieved from a prospectively maintained database with a minimum six-month follow-up. The median duration of follow-up was nine months (range: 6-15 months). Inclusion criteria included patients of any age with benign indications; exclusions included malignancy, major comorbidities, and referrals from other centers. Standard technique involved end-to-side anastomosis using 4-0/5-0 absorbable sutures, often via the Hepp-Couinaud approach. Statistical analysis was performed using the chi-square test.

Results: The cohort comprised 100 patients, predominantly 66 (66%) female patients, and most commonly aged 31-40 years. The primary indication for Roux-en-Y hepaticojejunostomy was choledochal cysts in 52 (52%) patients, followed by bile duct injuries in 33 (33%) patients. Long-term complications included recurrent cholangitis in 39 (39%) patients and anastomotic stricture in 20 (20%) patients. Stricture rates were the highest among patients with bile duct injuries. There was no significant association between sex and stricture development (p = 0.58). A near-significant trend was observed between younger age (<40 years) and a higher stricture incidence (p = 0.063). Postoperative bile leakage (p = 0.021) and cholangitis (p < 0.001) were strong predictors of anastomotic stricture formation.

Conclusion: Roux-en-Y hepaticojejunostomy for benign biliary diseases is associated with considerable late morbidity, particularly following bile duct injury. Postoperative bile leak and early cholangitis emerged as key modifiable predictors of anastomotic stricture. From a technical perspective, construction of a wide, tension-free mucosa-to-mucosa anastomosis at the hepatic hilum, preferably using the Hepp-Couinaud approach whenever feasible, is likely protective by ensuring optimal vascularity and reducing anastomotic narrowing. Younger patients may therefore require closer surveillance.