Hepaticojejunostomy

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Oskar Sprengel published the first report of a choledochoenterostomy in 1891. ^[1]  He found that in one case, attempting to clear the distal common bile duct of stones would be impossible through standard methods. At this time, he made a choledochotomy in the common bile duct and anastomosed it to the duodenum. Attempts to repeat this operation resulted in multiple deaths, likely from sequelae related to bile leaks. ^{[2, 3]}  By the early 1900s, two basic principles had been formulated that helped popularize this procedure. These principles were as follows:

Laparoscopic and robot-asisted approaches to hepaticojejunostomy have also been described; additional study is needed to determine their appropriate utilization. ^{[4, 5, 6]}

The major indications for hepaticojejunostomy are as follows:

 Additionally, obstruction from malignancies of the biliary system caused by pancreatic or duct wall tumors may necessitate this operation. Rare indications are trauma and dilated areas occurring in sclerosing cholangitis. In the pediatric population, choledochal cysts are also an indication for reconstruction with hepaticojejunostomy. ^[11]  Because each unsuccessful attempt at repair can cause increased morbidity for the patient, providing long-term functional and anatomic stability is paramount during the reconstruction. ^[12]

Patients with severe systemic illness (eg, severe cardiac or pulmonary dysfunction) should be cleared preoperatively to confirm that they are able to tolerate this procedure. The presence of proximal obstruction to bile flow in a given patient is also a contraindication for this procedure.

A muli-institutional analysis by Ismael et al used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to study 30-day outcomes in 293 patients treated with hepaticojejunostomy for repair of complex bile duct injury. ^[13]  The 30-day morbidity was 26.3%, and the mortality was 2%. Factors associated with increased morbidity were as follows:

Sprengel O. Uber eienen fall von exstirpation der gallenblase mit anlegung einer kommunikation zwischen duodenum und ductus choledochus. Zentralbl Chir. 1891. 18:121-122.

Sasse F. Uber choledochoduodenostomie. Zentralbl Chir. 1913. 40:942-943.

Santore MT, Behar BJ, Blinman TA, Doolin EJ, Hedrick HL, Mattei P. Hepaticoduodenostomy vs hepaticojejunostomy for reconstruction after resection of choledochal cyst. J Pediatr Surg. 2011 Jan. 46(1):209-13. [Medline].

Cuendis-Velázquez A, Morales-Chávez C, Aguirre-Olmedo I, Torres-Ruiz F, Rojano-Rodríguez M, Fernández-Álvarez L, et al. Laparoscopic hepaticojejunostomy after bile duct injury. Surg Endosc. 2016 Mar. 30 (3):876-82. [Medline].

Lai EC, Tang CN. Robot-assisted laparoscopic hepaticojejunostomy for advanced malignant biliary obstruction. Asian J Surg. 2015 Oct. 38 (4):210-3. [Medline].

Prasad A, De S, Mishra P, Tiwari A. Robotic assisted Roux-en-Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury. World J Gastroenterol. 2015 Feb 14. 21 (6):1703-6. [Medline].

Lubikowski J, Post M, Białek A, Kordowski J, Milkiewicz P, Wójcicki M. Surgical management and outcome of bile duct injuries following cholecystectomy: a single-center experience. Langenbecks Arch Surg. 2011 Jun. 396 (5):699-707. [Medline].

Schmidt SC, Fikatas P, Denecke T, Schmaucher G, et al. Hepatic resection for patients with cholecystectomy related complex bile duct injury. Eur Surg. 2010. 42:77-82.

Mathisen O, Søreide O, Bergan A. Laparoscopic cholecystectomy: bile duct and vascular injuries: management and outcome. Scand J Gastroenterol. 2002 Apr. 37(4):476-81. [Medline].

Schmidt SC, Settmacher U, Langrehr JM, Neuhaus P. Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery. 2004 Jun. 135(6):613-8. [Medline].

Hung MH, Lin LH, Chen DF, Huang CS. Choledochal cysts in infants and children: experiences over a 20-year period at a single institution. Eur J Pediatr. 2011 Sep. 170 (9):1179-85. [Medline].

Toumi Z, Aljarabah M, Ammori BJ. Role of the laparoscopic approach to biliary bypass for benign and malignant biliary diseases: a systematic review. Surg Endosc. 2011 Jul. 25 (7):2105-16. [Medline].

Ismael HN, Cox S, Cooper A, Narula N, Aloia T. The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford). 2017 Apr. 19 (4):352-358. [Medline].

Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat. 2004 Jun. 26(3):239-44. [Medline].

Northover JM, Terblanche J. A new look at the arterial supply of the bile duct in man and its surgical implications. Br J Surg. 1979 Jun. 66(6):379-84. [Medline].

Felder SI, Menon VG, Nissen NN, Margulies DR, Lo S, Colquhoun SD. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction. JAMA Surg. 2013 Mar. 148(3):253-7; discussion 257-8. [Medline].

Diao M, Li L, Li Q, Ye M, Cheng W. Single-incision versus conventional laparoscopic cyst excision and roux-y hepaticojejunostomy for children with choledochal cysts: a case-control study. World J Surg. 2013 Jul. 37(7):1707-13. [Medline].

Abdullah SS, Mabrut JY, Garbit V, De La Roche E, Olagne E, Rode A, et al. Anatomical variations of the hepatic artery: study of 932 cases in liver transplantation. Surg Radiol Anat. 2006 Oct. 28(5):468-73. [Medline].

Gupta N, Solomon H, Fairchild R, Kaminski DL. Management and outcome of patients with combined bile duct and hepatic artery injuries. Arch Surg. 1998 Feb. 133(2):176-81. [Medline].

Dawson DL, Johansen KH, Jurkovich GJ. Injuries to the portal triad. Am J Surg. 1991 May. 161(5):545-51. [Medline].

Katsinelos P, Paroutoglou G, Beltsis A, Tsolkas P, Arvaniti M, Katsiba D, et al. Endobiliary endoprosthesis without sphincterotomy for the treatment of biliary leakage. Surg Endosc. 2004 Jan. 18(1):165-6. [Medline].

Jester AL, Chung CW, Becerra DC, Molly Kilbane E, House MG, Zyromski NJ, et al. The Impact of Hepaticojejunostomy Leaks After Pancreatoduodenectomy: a Devastating Source of Morbidity and Mortality. J Gastrointest Surg. 2017 Jun. 21 (6):1017-1024. [Medline].

Michelassi F, Ranson JH. Bile duct disruption by blunt trauma. J Trauma. 1985 May. 25(5):454-7. [Medline].

Sawaya DE Jr, Johnson LW, Sittig K, McDonald JC, Zibari GB. Iatrogenic and noniatrogenic extrahepatic biliary tract injuries: a multi-institutional review. Am Surg. 2001 May. 67(5):473-7. [Medline].

AbdelRafee A, El-Shobari M, Askar W, Sultan AM, El Nakeeb A. Long-term follow-up of 120 patients after hepaticojejunostomy for treatment of post-cholecystectomy bile duct injuries: A retrospective cohort study. Int J Surg. 2015 Jun. 18:205-10. [Medline].

Sharma A, Hammond JS, Psaltis E, Dunn WK, Lobo DN. Portoenterostomy as a Salvage Procedure for Major Biliary Complications Following Hepaticojejunostomy. J Gastrointest Surg. 2017 Jun. 21 (6):1086-1092. [Medline].

Fazia Mir, MD Fellow, Department of Gastroenterology, University of Missouri-Columbia School of Medicine

Fazia Mir, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Keith D Gray, MD, FACS Chief, Division of Surgical Oncology, Assistant Professor, Department of Surgery, University of Tennessee Graduate School of Medicine; Medical Director, Gastrointestinal Tumor Service (GITS), The University of Tennessee Medical Center Cancer Institute; Clinical Specialist, Department of Surgery, The University of Tennessee Medical Center

Keith D Gray, MD, FACS is a member of the following medical societies: American Association for Cancer Research,American College of Surgeons, National Medical Association, Society of Surgical Oncology, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Khanjan H Nagarsheth, MD Chief Resident in General Surgery, Department of Surgery, University of Tennessee Health Science Center College of Medicine

Khanjan H Nagarsheth is a member of the following medical societies: American College of Surgeons and Tennessee Medical Association

Disclosure: Nothing to disclose.

Hepaticojejunostomy

Research & References of Hepaticojejunostomy|A&C Accounting And Tax Services
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