hepaticojejunostomy

Hepaticojejunostomy is a surgical procedure that creates a direct connection between the hepatic biliary tree and the jejunum to restore bile drainage when the bile ducts are obstructed or damaged. It bypasses the obstructed segment by draining bile into the small intestine.

Indications include benign biliary strictures (such as postinflammatory or postoperative scarring), malignant obstruction at the hilum or common hepatic duct, iatrogenic bile duct injury during cholecystectomy, trauma, and biliary atresia or other congenital biliary anomalies in children.

The procedure is most commonly performed as a Roux-en-Y hepaticojejunostomy. After exposure of the hepatic hilum, a segment of jejunum is mobilized and arranged as a Roux limb. A mucosa-to-mucosa anastomosis is created between the hepatic duct (or hepatic duct confluence) and the jejunal mucosa, using a tension-free, well-vascularized connection. The anastomosis may be end-to-end or end-to-side and is commonly protected with a temporary stent or drain. Techniques can be open, laparoscopic, or robotic, depending on anatomy and surgeon experience.

Postoperative care focuses on monitoring for biliary leaks, infection, and ensuring patency. Liver function tests and imaging assess flow. Long-term patency is generally favorable, but complications such as anastomotic stricture, cholangitis, or leaks can occur and may require endoscopic or percutaneous intervention or revision. Alternatives in select cases include hepatic ductoplasty or hepaticoduodenostomy.