The Curative Effect Of Subcutaneous Jejunal Blind Loop On Roux-en-Y Anastomosis In The Treatment Of Intrahepatic Bile Duct Stones

Objective:Analyze the effect of subcutaneous jejunal blind loop on Roux-en-Y anastomosis in the treatment of intrahepatic bile duct stones.Methods: Retrospective analysis of 255 cases of Roux-en-Y choledochojejunostomy from August 2011 to August 2018 in the treatment of intrahepatic bile duct stones in Department of Biliary and Pancreatic Surgery,Tongti Hospital.Of these people,93 patients retain subcutaneous jejunal blind loop during operation(modify group)and 162 patients not(control group).47 patients in 255 cases were underwent secondry Roux-en-Y cholangiojejunostomy(reoperation group)and 8 patients of modify group underwent operation using the jejunal blind loop(local anesthesia operation group).Demographic factors,perioperative outcomes,postoperative outcomes,operation related outcomes and complications were examined between the modify group and control group,so as to second operation group and local anesthesia operation group.Results: Patients in modify group had longer operation time than control group,but there are no different(260.3±34.8 min VS 249.5±33.1 min,P>0.05),there are no difference in other outcomes.Patients in local anesthesia operation group had lower leukocyte count(12.3±0.9* VS 15.6±4.4*,P<0.05),shorter operation time(83.3±9.4 min VS 256.2±33.4 min,P<0.05),less intraoperative blood loss(28.8±15.5 ml VS 285.4±75.4 ml,P<0.05),earlier anal ventilation time(1.5±0.5d VS 4.1±1.0 d,P<0.05),shorter hospital stays(6.6±1.1 d VS 24.2±7.0d,P<0.05)than second operation gourp,there are no difference in other outcomes.Conclusions:Indwelling the jejunal blind loop during Roux-en-Y anastomosis will not increase inflammatory reactions and complications and hospitalization time,and the operation time is slightly longer.However,for patients with intrahepatic stone remnant or recurrence which need treated,only local anesthesia operation is required through the jejunal blind loop indwelling during the last operation,which has smaller inflammatory reaction,shorter operation time,less intraoperative blood loss,earlier anal ventilation time and shorter hospitalization time.Therefore,the conclusions of this study suggest to indwelling subcutaneous jejunal blind loops during cholangiojejunostomy.