Introduction : Complicated recurrent pyogenic cholangitis (RPC) is a lifelong, progressive disease. A high rate of residual stones, recurrent stones and repeated symptoms after the initial surgery are the major concern. Reoperation can be a formidable challenge and definitely hazardous, and the patient morbidity is high because of dense adhesion, the risk of bleeding and nearby organ injury.

Methods : Roux-en-Y hepaticojejunostomy with subcutaneous access loop was done in all patients with complicated RPC admitted to Surgical Ward (3), Yangon General Hospital in 20 months duration. During one year follow up period, the patients having residual or recurrent stones with symptoms were chosen for stone removal using choledochoscope via access loop. Outcome was determined by successful utilization of the access loop, clearance of the stones and relief of the symptoms after the procedure.

Results : There were 77 patients who underwent Roux-en-Y hepaticojejunostomy with subcutaneous access loop. The overall incidences of residual stone, stone recurrence and symptom recurrence were 27.2%, 13.6% and 31.8%. Total ten sessions of choledochoscopic stone removal were done in eight patients. Successful utilization of the access loop was accomplished in 85.7%. There were 75% successful stone clearance. Symptom relief after endoscopic intervention was 88.9%. There was no complication after the procedure. The mean hospital stay after procedure was 2.6 days.

Conclusions : Subcutaneous hepaticojejunal access loop is effective in treating residual and recurrent calculi occurred in complicated RPC. High success rates, short hospitalization periods, and no complications make it a well-accepted method for management of complicated RPC.