ERCP after Hepaticojejunostomy

This one's for the googlers who are seeking out information on an ERCP (Endoscopic Retrograde Cholangiopancreatography) after hepaticojejunostomy. (You can sort of see a diagram of hepaticojejunostomy here. Or you can look at the picture to the right - it's a little different than our situation, where there is not as much duct at 39, but gives you a little visual.)

Due to bile duct injury during a laparoscopic gall bladder surgery, my daughter had a hepaticojejunostomy. The bile ducts that were operated on began to narrow, as they do in about 20% of the cases after being operated on. Now we are looking at biliary stenting or stretching of the narrowed ducts.

Our regular local doctor who does plenty of ERCPs did not want to do the ERCP on Naomi because of the roux-en-y procedure done during the hepaticojejunostomy. He did not feel he could get the scope down into her because of the changed anatomy. This doctor had done a scope procedure on her immediately after the gall bladder surgery in February.

So we went to a regional super specialist, and had the procedure at a beautiful academic medical center where we felt they would have appropriate equipment and such. Unfortunately, after going under general anesthesia and having the scope down her throat pretty far down there, the doctors were unable to get to the area of the anastomosis in order to see what's going on and to use a balloon to stretch the bile ducts and/or insert a stent in the bile ducts.

So now we are evaluating other things, like trying to do an ERCP again or doing a PTC (Percutaneous Transhepatic Cholangiography). If they do a PTC, they will go through the skin and liver, guided by radiation the whole time, and do the balloon stretching of the duct or insert a stent in the duct. The downside is that you have a little tube hanging out of you for a few months.

So, we are thinking about the options for a few days. Our conclusion is that the ERCP is not always successful after hepaticojejunostomy. Our other conclusion is that if you are having laparoscopic gall bladder removal, try for a surgeon who has done more than 25 of the procedures. That is the magic number for improving the rate of success for surgery, according to the National Institutes of Health.

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