COMPARISON OF OUTCOME IN ROUX-Y HEPATICOJE-JUNOSTOMY WITH AND WITHOUT TRANSANASTMOTIC TUBE DRAINAGE IN TERTIARY CARE HOSPITAL

Abstract

Abstract

Aim:  To compare the incidence of post operative bile leakage in Roux-Y hepaticojejunostomy with and with-out transanastmotic Tube drainage placement.

Background:  A biliary-enteric anastmosis (Roux-en-Y hepaticojejunostomy) is usually needed after comp-lex injuries and for benign biliary pathologies. Place-ment of transanastmotic Tube drainage is a matter of debate and to our knowledge there is no study that compares the results regarding biliary leakage in Rou-x-Y hepaticojejunostomy with and without transanas-tmotic Tube drainage.

Design:  Randomized controlled Trial.

Setting:  Tertiary care center, Fatima Memorial Hos-pital Lahore.

Methods:  All the adult patients who were either adm-itted through OPD or referred to our hospital from September 2009 to September 2013 for Roux-Y hepa-ticojejunostomy for acute or elective reconstruction of the biliary tract. The patients were randomized into 2 groups: group A those who underwent Roux-en-Y he-

Shakir J.¹

Associate Professor, Department of Surgery

Fatima Memorial Hospital, Shadman, Lahore

 Bilal Y.²

Registrar Department of Surgery

Fatima Memorial Hospital, Shadman, Lahore

paticojejunostomy with transanastmotic Tube drainage and group B without transanastmotic Tube drainage.

Main Outcome Measures:  Anastmosis leakage, hos-pital stay.

Results:  Total 50 patients including high and com-plex biliary injuries (Bismuth type III, IV; Strasberg D, E) choledochal cyst and biliary strictures. Twenty five cases had reconstruction with the placement of transanastmotic Tube drainage and 25 cases without transanastmotic Tube drainage. No operative mortality was observed. The postoperative outcomes of both groups were compared and significant differences observed. Good results were observed in more than 90% of the patients with biliary drainage. Biliary lea-kage more frequent in patients having no external bili-ary drainage (24% vs. 4%).

Conclusions:  Good results are obtained with a Roux-en-Y hepaticojejunostomy with transanastmotic Tube drainage. We recommend that all patients who under-go Roux-en-Y hepaticojejunostomy should have Tra-nsanastmotic Tube drainage.