Open Hepaticojejunostomy
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Open Hepaticojejunostomy

This Open Hepaticojejunostomy course will teach you:

  • The restoration of bile flow by establishing flow into the proximal gastrointestinal tract. Restoration may be indicated if bile flow is impaired, either due to obstruction or leakage

Special attention is paid to the following hazards you may encounter during the Open Hepaticojejunostomy:

  • Common bile duct injury
  • Hepatic artery proper and portal vein injury
  • Compromising vasculature of the common hepatic duct
  • Incomplete bile drainage
  • Loss of mesenteric mobility
  • Compromising proximal jejunal arteries
  • Incorrect size of the orifice in the transverse mesocolon
  • Twisted mesentery of the jejunum
  • Entrapment of small intestine

With the following tips you might perform the Open Hepaticojejunostomy even better:

  • Extension of the incision across the midline
  • Transection of the round ligament of the liver
  • Dissection plane exposure
  • Optimization of access to the hilum of the liver
  • Pringle maneuver
  • Common hepatic duct isolation
  • Common hepatic duct identification
  • Level of common hepatic duct isolation
  • Determination of the transection site of the proximal common hepatic duct
  • Cultures and histologic exam of common hepatic duct tissue
  • Irrigation of the proximal common hepatic duct
  • Viable edges of transected duct
  • Examination of the blood supply to the jejunum
  • Jejunal artery isolation
  • Mesenteric and jejunal mobilization
  • Catching staples on gauze swab
  • Transection and closure of distal end of the jejunum
  • Determination of transection point of transverse mesocolon
  • Location on the jejunum for end -to – side jejunal anastomosis
  • End -to – side anastomosis creation
  • End -to – end anastomosis creation: Blumgart technique
  • Distance between different sutures
  • The number of extra introduced sutures
  • Tying of standing sutures
  • Opening of the jejunum after anastomosis of the posterior wall
  • Extra suture row anterior wall of the anastomosis
  • Closure of the mesentery
  • Covering the hepaticojejunostomy by the round ligament of the liver

After studying the Open Hepaticojejunostomy course you are familiar with the most common complications:

  • Anastomotic leakage of the hepaticojejunostomy
  • Anastomotic leakage of the jejunojejunostomy
  • Anastomotic stricture of the hepaticojejunostomy
  • Postoperative ileus
  • Internal herniation

You might also be interested in:
Open Pylorus Preserving Pancreaticoduodenectomy (PPPD)

Step by step

Abdominal cavity approach

Skin

Mark

Mark the skin starting approximately 2.5 cm caudal to the xiphoid process, extending 10-15 cm obliquely down to the right, following the border of the costal arch as per Kocher’s incision.

Incise

Incise the skin over the previous marking.

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