roux en y hepaticojejunostomy hernia-does he or doesn't he?
As some of you know, Lee had botched gallbladder surgery. Used as an experiment (from an experienced VA hosptial surgeon), he has had approximately seven months now of aftermath events. NOW my biggest concern is the potential of his having a very dangerous hernia, one of the potential effects of the corrective surgery. (roux en y hepaticojejunostomy)- and so I am looking for the signs and symptoms. Was hoping for comfort, not concern, but his two biggest physical displays now are pain and protrustion (hard), and that COULD still be normal, or not. --'Cheyenne Cin' -- P.S. I was hoping that a definite sign would be turning yellow or jaundiced again, which he is not doing right now, and then we could be comforted knowing he has no potential for developing this complication. Sadly, there are so many unknown variables after this, that even the doctors and nurses have to do some guesswork.
Another thing, Lee insisted on a blood test a few days ago, although they set his next doctor's appointment up for later in March- he hasn't seen the doctor for awhile now. Is that normal? I sure hope so. He is GREAT about insisting upon attention when necessary, like by insisting upon this latest blood test and having them relay back to us results. By the way, his inflammation level - apparently that can be read in the blood- is down, not yet to normal level but much closer than the LAST test he had shortly after the surgery (December 1, 2004, I think)- but his cholesterol level has skyrocketed to 230, much higher. Nobody knows why, and Lee is careful what he eats. It's one of the 'mysteries' of this- is that normal or not? Laura, the woman at the Cheyenne VA, who gave us the readings (results) on the phone, told us that nobody really knows why this happened, but they will certainly address it and recheck on his appointment, I'm sure. Lee is supposed to be getting priority medical care now. As concerned as I am about this newest cholesterol development, I am more concerned about the possibility of a hernia. More because there may not be a way to know, perhaps Lee should demand an x-ray??? Wish I knew if the indications of a hernia would have shown up in his blood test? Meanwhile, we have a lot of faith in the Lord's intervention, and in the prayers from everyone!
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roux en y hepaticojejunostomy
hernia (google search)
| Higa KD, Ho T, Boone KB. | Related Articles, Links | ||||||
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Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence,
treatment and prevention.
Higa KD, Ho T, Boone KB. Valley Surgical Specialists, Fresno, CA, USA. higanoid@... BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGBP) has been shown to be a safe and effective alternative to traditional "open" RYGBP. Although lack of postoperative adhesions is one advantage of minimally invasive surgery, this is also responsible for a higher incidence of internal hernias. These patients often present with intermittent abdominal pain or small bowel obstruction with completely normal contrast radiographs. METHODS: Data was obtained concurrently on 2,000 consecutive patients from February 1998 to October 2001 and analyzed retrospectively. Radiographs, when available, were interpreted by both the operative surgeon and radiologist before intervention. RESULTS: 66 internal hernias occurred in 63 patients, an incidence of 3.1%. 1 patient presented with a traditional adhesive band and small bowel obstruction. 20% of patients had normal preoperative small bowel series and/or CT scans. The site of internal hernias varied: 44 - mesocolon; 14 - jejunal mesentery; 5 - Petersen's space. Although most patients were symptomatic, 5% were incidental findings at the time of another surgical procedure. 5 patients required open repair. 6 patients presented with perforation either at the time of diagnosis or as a result of manipulation of the bowel. There was 1 death associated with complications of the internal hernia. The negative exploration rate was 2%. CONCLUSION: Internal hernias are more common following laparoscopic RYGBP than "open" RYGBP. Contrast radiographs alone are unreliable in ruling out this diagnosis. Early intervention is crucial; most repairs can be performed laparoscopically. This diagnosis should be entertained in all patients with unexplained abdominal pain following laparoscopic RYGBP. Meticulous closure of all potential internal hernia sites is essential to limit this potentially lethal complication. ===========================================
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Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003 Jun;13(3):350-4. | ||||||
Internal hernia of the small bowel after right-lobe live donor liver transplantation.
Liu CL, Lo CM, Chan SC, Fan ST, Wong J.
Centre for the Study of Liver Disease, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. clliu@...
Internal hernia of small bowel is an uncommon but potentially fatal complication of liver transplantation. We report on four patients in whom internal hernia of small bowel occurred after right-lobe live donor liver transplantation (LDLT). Three patients had small bowel herniation with volvulus around the Roux-en-Y loop whereas the other patient had herniation through the mesenteric window of transverse mesocolon after hepaticojejunostomy for biliary reconstruction. Based on clinical and radiologic findings, early diagnosis was made in all cases. All patients survived following surgical reduction of the hernia and closure of the mesenteric defect without bowel resection. Transplant surgeons should be aware of this serious complication so that early diagnosis and appropriate operative intervention can be made. The complication can be avoided with duct-to-duct biliary reconstruction or meticulous closure of all mesenteric defects with non-absorbable suture materials after hepaticojejunostomy in patients undergoing right-lobe LDLT.
Liu CL, Lo CM, Chan SC, Fan ST, Wong J.
Centre for the Study of Liver Disease, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. clliu@...
Internal hernia of small bowel is an uncommon but potentially fatal complication of liver transplantation. We report on four patients in whom internal hernia of small bowel occurred after right-lobe live donor liver transplantation (LDLT). Three patients had small bowel herniation with volvulus around the Roux-en-Y loop whereas the other patient had herniation through the mesenteric window of transverse mesocolon after hepaticojejunostomy for biliary reconstruction. Based on clinical and radiologic findings, early diagnosis was made in all cases. All patients survived following surgical reduction of the hernia and closure of the mesenteric defect without bowel resection. Transplant surgeons should be aware of this serious complication so that early diagnosis and appropriate operative intervention can be made. The complication can be avoided with duct-to-duct biliary reconstruction or meticulous closure of all mesenteric defects with non-absorbable suture materials after hepaticojejunostomy in patients undergoing right-lobe LDLT.
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Long-term curative effects of combined hepatocholangioplasty with choledochostomy through an isolated jejunum passage on hepatolithiasis complicated by stricture
Long term results of Roux-en-Y hepaticojejunostomy. ...
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(THIS IS WHY I am looking up this information-it's March 3, 2005, and Lee has had pain ever since his reconstructive surgery for having severed his bile duct. He has a real hard, protruding spot right where his own intestine was rerouted and attached to the dangling segment of his bile duct, with a hole cut into the side of what was left of his bile duct, and the clips that were left at the bottom of the severed bile duct are still there- the doctor and attendants performing the 'routine' gallbladder removal surgery left multiple clips there and didn't even know it! Anyway, back to the potential problem- he has pain, and he has the protrusion and the hardness where the surgery was done and his intestines were tampered with. One of the potential complications in the aftermath is a hernia. We want NO DANGERS or threats to Lee's life. We don't know if there actually is a problem, and that is why I am now looking up 'signs and signals' - the doctors at the VA hosptial have said he will have pain for up to a year. Lee has kept them informed, and we have to depend on them and their expertise. However, a little 'extra' knowledge never hurts!--"Cheyenne Cin")
Glossary H: Medical Litigation News
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... Hepaticojejunostomy, Roux-en-Y The surgical ... Hernia, [strictly Para-]Umbilical Protrusion of abdominal contents through a defect in the normally-restraining ...
www.medlit.info/guests/glossary/glossH.htm Hepaticojejunostomy, Roux-en-Y The surgical fashioning of a direct connection between hepatic duct and jejunum to drain bile directly from the liver when disease or injury has damaged the bile ducts.
Hernia, [strictly Para-]Umbilical Protrusion of abdominal contents through a defect in the normally-restraining muscle tissues of the abdominal wall adjacent to the navel. Hernia, Abdominal Protrusion of abdominal contents through a defect in the normally-restraining muscle tissues of the abdominal wall. Hernia, Diaphragmatic A pathological protrusion of abdominal organs through a defect in the diaphragm. Hernia, Inguinal Protrusion of abdominal contents through a defect in the normally-restraining tissues of the groin. Hernia, Incisional The protrusion of an organ or tissue through an inadequately healed surgical scar, usually only the inner layers. Hernia The protrusion of a part or a structure through the tissues normally containing it. Hernial Sac The peritoneal envelope of a Hernia. |
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Medical Word - Hepaticojejunostomy Roux-En-Y |
Ans: The surgical fashioning of a direct connection between hepatic duct and jejunum to drain bile directly from the liver when disease or injury has damaged the bile ducts. |
| Hernia |
| Hernia, abdominal |
| Hernia, diaphragmatic |
| Hernia, incisional |
| Hernia, inguinal |
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Digestive Disorders
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