Hepaticojejunostomy in Minimally Invasive Surgery: A Step-by-Step Guide

Minimally Invasive Hepaticojejunostomy

Article information

J Surg Innov Educ. 2024;1(2):53-54

Publication date (electronic) : 2024 December 12

doi : https://doi.org/10.69474/jsie.2024.00192

, Wooil Kwon

Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

Corresponding author: Wooil Kwon, MD, PhD Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea Tel: +82-2-2072-2817, Fax: +82-2-766-3975, E-mail: willdoc78@gmail.com

Received 2024 November 8; Accepted 2024 November 25.

Abstract

With rapid advances in minimally invasive surgery (MIS) techniques, such as laparoscopy and robotics, their application has expanded across various surgical fields, including pancreatobiliary surgery. Numerous studies have demonstrated the feasibility and potential benefits of MIS. Hepaticojejunostomy, a procedure creating a connection between the hepatic duct and the jejunum, is primarily used to bypass biliary obstructions or during operations that involve bile duct resection, such as pancreatoduodenectomy or choledochal cyst excision. Proficiency in minimally invasive hepaticojejunostomy techniques is essential for surgeons in this evolving field. This video presents a detailed, step-by-step guide to the principles and techniques of performing hepaticojejunostomy using both laparoscopic and robotic platforms.

Chapter Summary

00:00:01 Introduction

00:00:10 History of bilioenteric anastomosis

00:00:35 Definition and indication of hepaticojejunostomy

00:01:03 Principles of anastomosis

00:01:17 Three steps in hepaticojejunostomy

00:01:35 Port placement

00:01:54 Laparoscopic hepaticojejunostomy

00:02:02 Stage 1: jejunal preparation

00:02:11 Stay suturing

00:02:37 Jejunal transection

00:03:01 Mesenteric opening formation

00:03:32 Stage 2: anastomosis

00:03:34 Jejunal incision formation

00:03:44 Stay suturing

00:04:11 Posterior wall interrupted suturing

00:05:11 Anterior wall interrupted suturing

00:06:01 Stage 3: limb anchoring

00:06:04 Interrupted suture of jejunum and mesenteric opening

00:06:20 Application of fibrin glue

00:06:29 Advantages of robotic surgery

00:06:51 Robotic hepaticojejunostomy (interrupted method)

00:07:00 Posterior wall interrupted suturing

00:07:34 Silastic tube indwelling

00:07:49 Anterior wall interrupted suturing

00:08:22 Robotic hepaticojejunostomy (continuous method)

00:08:36 Posterior wall continuous suturing

00:09:35 Silastic tube indwelling

00:09:48 Anterior wall interrupted suturing

Notes

Disclosure

No potential conflict of interest relevant to this article was reported.

References

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2. Sahoo MR, Ali MS, Sarthak S, Nayak J. Laparoscopic hepaticojejunostomy for benign biliary stricture: a case series of 16 patients at a tertiary care centre in India. J Minim Access Surg 2022;18:20–24.

3. Ahrendt SA, Pitt HA. A history of the bilioenteric anastomosis. Arch Surg 1990;125:1493–1500.

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