Surgical Outcomes of Roux-en-Y Hepaticojejunostomy in a Plethora of Clinical Scenarios and the Credibility of Suture Techniques: Experience at a Single Indian Tertiary Care Center in Tamil Nadu.

Background: Roux-en-Y hepaticojejunostomy (RYHJ) is the standard reconstructive procedure for restoring biliary continuity in a variety of benign biliary pathologies. Postoperative outcomes may be influenced by patient-related factors, inflammatory status, operative parameters, and anastomotic techniques. Aim: This study evaluated surgical, functional, and quality of life (QoL) outcomes following elective RYHJ, with a comparison between interrupted and continuous suturing techniques. Materials and methods: This single-center observational study included 121 patients who underwent elective RYHJ for benign biliary disease at a tertiary care hospital in Tamil Nadu. Patients with malignant biliary obstruction, emergency biliary reconstruction, pancreaticoduodenectomies, hepatectomies, liver transplantation, or incomplete follow-up were excluded. Preoperative, intraoperative, and postoperative variables were analyzed. Postoperative complications were graded using the Clavien-Dindo classification, functional outcomes were assessed using the McDonald classification, and QoL was evaluated using the WHOQOL-BREF questionnaire. Statistical analysis was performed using the Chi-square test or Fisher's exact test, with Results: Most patients were aged 31-60 years (68.6%), with a slight female predominance (54.5%). Interrupted anastomosis was performed in 82.6% of cases. Early postoperative complications occurred in 20.7% of patients, with bile leak observed in 18.2%, while late anastomotic strictures occurred in 11.6%. Major complications (Clavien-Dindo grade ≥ III) were seen in 17.4% of patients. On long-term follow-up, 71.9% achieved McDonald Grade A functional outcomes, and 87.6% demonstrated good or improved WHOQOL-BREF scores. No significant differences were observed between interrupted and continuous anastomotic techniques for any postoperative outcome ( Conclusion: Elective RYHJ for benign biliary disease is associated with favorable surgical, functional, and QoL outcomes, with low rates of early and late complications. Interrupted and continuous anastomotic suturing techniques yield comparable postoperative results, indicating that patient-related and operative factors, rather than suturing technique, are the principal determinants of outcome. Clinical significance: This study highlights that postoperative outcomes and QoL following RYHJ are influenced more by patient-related and disease-related factors than by the choice of suturing technique. These findings support a tailored surgical approach and emphasize optimization of patient condition and meticulous perioperative care to improve functional and QoL outcomes in benign biliary reconstruction.