What Is a Hepaticojejunostomy?

A hepaticojejunostomy, or Roux-en-Y procedure, bypasses the bile duct to allow digestive juices to drain from the liver directly into the small intestine.

The hepatic duct is the tubular channel that carries bile from the liver to the small intestine to aid digestion. A hepaticojejunostomy is a surgical procedure to make a connection (anastomosis) between the hepatic duct and the jejunum, which is the middle portion of the small intestine. This technique is called the Roux-en-Y hepaticojejunostomy.

An alternative procedure is hepaticoduodenostomy, which creates an anastomosis between the hepatic duct and the duodenum, the beginning portion of the small intestine.

A hepaticojejunostomy may be performed as

• Open surgery: The surgeon makes a long, midline or right incision and uses surgical tools typical for performing open abdominal surgeries.
• Laparoscopic surgery: The surgeon makes a single or several tiny incisions. The surgeon then performs the procedure with tiny surgical tools inserted through a flexible tube with a lighted camera (laparoscope).
• Robotic laparoscopic surgery: A robot operates the tiny surgical tools in the laparoscope. The surgeon uses a computer terminal to direct and control the robotic equipment.

Normally, the hepatic duct joins the cystic duct (the duct that carries bile from the gallbladder) to form the common bile duct that drains the bile into the duodenum. When disease or injury in the biliary system obstructs the free flow of bile, digestion is impaired.

A hepaticojejunostomy is performed to ensure that the bile from the liver freely drains into the intestine. A hepaticojejunostomy may be performed to treat conditions such as:

• Benign strictures in the common bile duct due to 
  • stones
  • inflammation
  • cysts
• Malignant strictures in the biliary system from tumors in the
  • liver
  • pancreas
  • gallbladder
  • bile duct
• After gall bladder removal for gallstones or other reasons
• Injury to the biliary system
• Liver transplantation

A hepaticojejunostomy is performed under general anesthesia by a gastrointestinal surgeon.

Preparation

Prior to a gastrojejunostomy the patient may be required to

• Undergo blood, urine, and imaging tests.
• Undergo specific imaging tests for biliary anatomy, such as magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
• Avoid eating or drinking 8 hours prior to the procedure.
• Check with the doctor before taking any regular medications.
• Inform the doctor of any allergies.
• Undergo a procedure to decompress the biliary system in case of complete obstruction, known as percutaneous transhepatic cholangial drainage (PTCD).

Procedure

• An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the procedure.
• The patient will be intubated to provide oxygen.
• The surgeon makes one or more incisions in the abdomen depending on the type of surgery.
• The surgeon cuts the jejunum about 25 cm to 30 cm from the end of the duodenum.
• The lower section of the jejunum is taken up to the upper right abdomen, close to the hepatic duct.
• The surgeon severs the hepatic duct above its junction with the cystic duct and attaches it to the jejunum with sutures.
• The upper section of the severed jejunal tract is connected to the jejunum farther down.
• The anastomosis is closed with sutures.
• A drain may be left in place.
• The abdominal muscles and the incision are closed with sutures.

Post-procedure

• The patient is brought out of anesthesia and administered painkillers for post-surgical pain.
• The patient will be monitored in the recovery room for several hours.
• The patient may need hospitalization for up to a week depending on the type of surgery.
• Complete recovery may take up to 6 weeks during which period the patient may need
• To be on a special diet
• Avoid heavy lifting
• Avoid strenuous activities

Hepaticojejunostomy is a commonly performed biliary reconstruction surgery. Complications associated with the procedure include:

• Side effects of anesthesia such as
  • nausea
  • headache
  • confusion
• Surgical risks such as
  • wound infection
  • hemorrhage
  • blood clots
  • pneumonia
  • damage to nearby organs, blood vessels or nerves
• Anastomotic leakage or stricture
• Collection of bile fluid in the abdominal cavity (biloma)
• Inflammation of the stomach lining (peritonitis)
• Abdominal abscess
• Inflammation or stone in the hepatic duct
• Incisional hernia
• Pancreatitis
• Infection and sepsis