General Surgery

Hepaticojejunostomy

OPERATION: Hepaticojejunostomy (Roux-en-Y)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: Given at induction
POSITION: Supine

INDICATION:
[Benign bile duct stricture / bile duct injury / hilar cholangiocarcinoma / post-cholecystectomy biliary reconstruction / choledochal cyst]. Previous imaging: [MRCP / ERCP results].

INCISION: Upper midline / right subcostal.

PROCEDURE:
WHO Checklist performed. Abdomen explored. [Adhesions divided]. Hepatoduodenal ligament dissected. Common hepatic duct / left and right hepatic ducts identified and mobilised. Duct divided at appropriate level — calibre [describe]. [Stricture / tumour managed as appropriate].

Roux-en-Y loop of jejunum fashioned: jejunum divided [50–60 cm] distal to duodenojejunal flexure with GIA stapler. Mesentery divided for adequate length. Roux loop brought up retrocolic / antecolic. Jejunojejunostomy fashioned end-to-side with GIA stapler.

Hepaticojejunostomy: anastomosis between bile duct [/ bilateral ductal openings] and Roux loop using single-layer interrupted 4/0 absorbable sutures. [Stent placed transanastomotically if ducts small / access required]. Tension-free, spatulated, watertight anastomosis confirmed.

Haemostasis confirmed. Drain placed at anastomosis. Wound closed.

FINDINGS:
[Bile duct calibre, nature of stricture, mucosa quality]. Anastomosis [tension-free, technically satisfactory].

EBL: [Volume] ml. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Drain bilirubin measured day 1 and 3. NG tube. Oral fluids when appropriate. Outpatient review with imaging at [6–8 weeks].