Late complications after hepatico- or choledocho-jejunostomy: Especially benign bilo-enteric anastomosis strictures and intrahepatic stones

Abstract

We reviewed late complications after hepaticojejunostomy or choledochojejunostomy, focusing on cholangitis, benign bilioenteric anastomotic stricture, and intrahepatic stones. The incidence/median time to onset was 4.4-43%/4-13.4 months after surgery for postoperative cholangitis, 1.9-18.6%/6.8-63 months after surgery for benign bilioenteric anastomotic stricture, and 2.4-10.2%/37.4 months-7.6 years after surgery for intrahepatic stones. Balloon enteroscopic and endoscopic ultrasound-guided approaches have become more widely utilized as biliary approaches among patients with surgically altered anatomy, such as those with hepaticojejunostomy or choledochojejunostomy. In recent years, the treatment of choice for bilioenteric anastomotic strictures and intrahepatic stones after hepaticojejunostomy or choledochojejunostomy has been the endoscopic approach, followed by the percutaneous approach, while attempting a surgical approach for cases with difficult improvement or when endoscopic/percutaneous transhepatic methods are not utilized.