Utilization of a Modified Roux-en-Y Anastomosis as an Access point for Percutaneous Transjejunal Cholangioplasty of Recurrent Biliary Strictures

  • Jagteshwar SandhuEmail author
  • Adam Swersky
  • Jason Salsamendi
  • Robert B. Abrahams
  • Shree Venkat
  • Danny Sleeman
  • Prasoon Mohan
Clinical Investigation Biliary
Part of the following topical collections:
  1. Biliary



Biliary duct injuries pose a significant management challenge due to the propensity for recurrent biliary strictures. Development of a modified Roux-en-Y hepaticojejunostomy known as a Hutson–Russell Pouch (HRP) provides a point of entry for repetitive access to the biliary tree. We aim to highlight the effectiveness of using the HRP as an access point for the long-term management of anastomotic and distal biliary strictures, thereby showcasing the value in potential widespread adoption of this modification to a standard surgical procedure.

Materials and methods

IRB-approved retrospective study of 36 patients (10 M, 26 F; mean age 55.19 ± 13.94; 15–83) underwent a total of 110 transjejunal cholangiograms. Indications for cholangiogram included cholangitis (n = 38), surveillance (n = 36), and elevated liver enzymes (n = 36). Technical success was defined by the ability to access and intervene in the biliary tree via HRP access. In case of stenosis, the ability to successfully dilate (< 30%) residual stenosis was considered a technically successful procedure. Clinical success was defined by normalization of the liver function tests or resolution of cholangitis.


Technical success was achieved in 83/110 (75.45%) of the cases, and clinical success was achieved in 102/110 (98.2%). Transhepatic access was needed in 27/110 (24.5%) of the cases. Interventions performed included balloon cholangioplasty in 104/110 (94.5%), biliary stone removal in 2/110 (1.8%), biliary stent placement in 2/110 (1.8%), and biliary drain placement in 4/110 (3.6%). There were a total of 9/110 complications (8.2%).


The HRP was an effective access point in the management of recurrent benign biliary strictures in this cohort.


Hutson–russell pouch Modified Roux-en-Y hepaticojejunostomy Transjejunal cholangiogram Cholangioplasty Percutaneous transhepatic cholangiogram Benign biliary strictures 



This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflicts of interest.

Ethical Approval

This study has obtained IRB approval from the University of Miami/Jackson Memorial Hospital, and the need for informed consent was waived.

Informed Consent

Consent for publication was obtained for every individual person’s data included in this study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.University of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Interventional RadiologyJackson Memorial Hospital/University of Miami Miller School of MedicineMiamiUSA
  3. 3.Diagnostic and Interventional RadiologistHaywood Medical ImagingClydeUSA
  4. 4.Department of SurgeryJackson Memorial Hospital/University of Miami Miller School of MedicineMiamiUSA

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