BACKGROUND: Hepaticojejunostomy following hepatobiliary resection has been performed using a Roux-en-Y jejunal limb via the antecolic or the retrocolic-anteduodenal route. However, in morbidly obese patients difficulty arises from the thickened, foreshortened mesentery of the jejunum and from limited mobility due to intra-abdominal fat deposition. METHODS: We developed new placement of Roux-en-Y jejunal limb in which the limb is placed via the retrocolic-retrogastric route. Hepaticojejunostomy via this route was performed in 133 obese and nonobese patients with biliary cancer. RESULTS: Tension-free anastomosis was successfully performed in all patients. Neither early nor late complications directly related to this new reconstruction route occurred. CONCLUSIONS: The retrocolic-retrogastric route is simple and an alternative to the standard methods of biliary reconstruction following hepatobiliary resection. This new placement may circumvent the obesity-related problem.
BACKGROUND: Hepaticojejunostomy following hepatobiliary resection has been performed using a Roux-en-Y jejunal limb via the antecolic or the retrocolic-anteduodenal route. However, in morbidly obesepatients difficulty arises from the thickened, foreshortened mesentery of the jejunum and from limited mobility due to intra-abdominal fat deposition. METHODS: We developed new placement of Roux-en-Y jejunal limb in which the limb is placed via the retrocolic-retrogastric route. Hepaticojejunostomy via this route was performed in 133 obese and nonobese patients with biliary cancer. RESULTS: Tension-free anastomosis was successfully performed in all patients. Neither early nor late complications directly related to this new reconstruction route occurred. CONCLUSIONS: The retrocolic-retrogastric route is simple and an alternative to the standard methods of biliary reconstruction following hepatobiliary resection. This new placement may circumvent the obesity-related problem.