Hepaticojejunostomy

Hepaticojejunostomy is performed when the common duct is stric-tured, usually because of tumor or biliary injury. Typically, an anastomosis is created between the common hepatic duct and a Roux-en-Y loop of jejunum (Figs. 4.38 and 4.39). A Roux-en-Y anastomosis, although more complicated to perform than a loop anastomosis, has the advantage of preventing reflux of intestinal contents into the biliary tree. It should therefore be done for benign disease where the long-term

Figure 4.39. Hepaticojejunostomy. Supine view Figure 4.38. Hepaticojejunostomy. An from a cholangiogram performed via an external anastomosis is created between a Roux- biliary drainage catheter shows filling of the en-Y loop of jejunum and the common intrahepatic biliary tree and anastomosed Roux-hepatic duct. en-Y loop of jejunum.

Figure 4.39. Hepaticojejunostomy. Supine view Figure 4.38. Hepaticojejunostomy. An from a cholangiogram performed via an external anastomosis is created between a Roux- biliary drainage catheter shows filling of the en-Y loop of jejunum and the common intrahepatic biliary tree and anastomosed Roux-hepatic duct. en-Y loop of jejunum.

prognosis for survival is good. The usual technique is a direct anastomosis of the jejunum to the common duct above the strictured segment. An alternative method is the Rodney Smith procedure, a sutureless technique in which the jejunal mucosa is made to approximate the biliary ductal epithelium by passage of a transhepatic catheter or catheters, which also serve as temporary stents (Fig. 4.40). Complications include leak and anastomotic stricture. The results depend on the level of the initial biliary narrowing, with higher lesions having a poorer prognosis [25].

FIGURE 4.40. Hepaticojejunostomy. Film from a cholangiogram in a patient following the Rodney Smith procedure shows stents in the left and right hepatic ducts entering the jejunal anastomosis.

Was this article helpful?

0 0

Post a comment