The Hepaticojejunostomy Technique with Intra-Anastomotic Stent in Biliary Diseases and Its Evolution throughout the Years: A Technical Analysis

Abstract

Roux-en-Y hepaticojejunostomy (RYHJ) is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal representative of biliary diversion procedures. This technique has met many milestones of extensive evolution, particularly the last years of concomitant technological evolution (laparoscopic/robotic approach). Anastomotic strictures and leaks, which may have deleterious effects on the survival and quality of life of a patient with biliary obstruction of any cause, made the need of the development of a safe and efficient RYHJ compulsory. The aim of this technical analysis and the juxtaposed discussions is to elucidate with the most important milestones and technical tips and tricks all aspects of a feasible and reliable RYHJ technique that is performed in our center for the last 25 years in around 400 patients.

Radiofrequency Energy in Hepatic Bed during Partial Cystectomy for Hydatid Liver Disease: Standing Out from the Usual Conservative Surgical Management

“…All in all, the rationale for the use of such a technique for the management of HLD lies in the fact that this technique seems to be efficient in terms of postoperative mortality, morbidity, and cost. Moreover, it seems to achieve comparable to radical surgery results in terms of recurrence, in hands of experienced liver surgeons [ 30 , 31 ]. Of course, this technique is not a typical “conservative” one, since expertise in using RF-energy devices is needed and it is not always accessible in general nonexpert centers in endemic areas.…”

Comparative analysis of different hepatico-jejunostomy techniques for treating adult type I choledochal cyst

“…For cases whose hepatic bifurcation was resected, the anastomotic diameter was measured intra-operatively. If the diameter of the anastomosis is <1.5 cm, we prefer to place a transanastomotic T-tube/orthopedic stent in order to protect and improve the patency of the anastomosis in the post-operative period [ 17 , 18 ]. We usually use a 16 Fr T-tube in case of small bile ducts.…”

“…We usually use a 16 Fr T-tube in case of small bile ducts. The RYHJ was performed in the same way as the Demetrios technique [ 18 ]. The parameters assessed included the demographic data, presenting symptoms, perioperative findings, post-operative complications and long-term outcomes.…”

Non-Whipple Operations in the Management of Benign, Premalignant and Early Cancerous Duodenal Lesions

“…Postoperatively, standardized management included clinical evaluation twice daily and daily analyses of blood and drain-fluid samples as described earlier (62)(63)(64)(65)(66). Postoperative mortality was defined as death occurring within 90 days after surgery or during hospital stay.…”