Complex Biliary Reconstruction
Hepaticojejunostomy with three hepatic ducts
00:16 OVERVIEW
03:24 ANTERIOR WALL SUTURES ON HEPATIC DUCTS
06:12 ENTEROTOMIES AND POSTERIOR WALL SUTURES
09:11 COMPLETE ANASTOMOSIS
Case Description
- This video demonstrates the anastomotic technique of hepaticojejunostomy with three hepatic ducts.
- Interrupted sutures are used both the anterior and posterior walls.
- The entire row of duct posterior walls will be completed first, followed by the anterior row.
- The sutures on the anterior walls of the hepatic ducts hold the anterior walls open to facilitate the posterior row suture placements.
- A W-maneuver is performed on the 9 o’clock stay suture during placements of the posterior wall sutures.
- Particular attention is paid to “string management” to organize the sutures and keep them from being entangled.
- The posterior wall sutures are tied on the inside, while the stay sutures and the anterior wall sutures are tied on the outside.
