Definition of Hepaticojejunostomy Procedure
Laparotomy is performed through the previous Makuuchi incision and
cholangiography is performed following catheterization of cystic duct
stump. In LLDs with an external PTBD catheter, radiologist place a
guide-wire through the catheter. The PTBD catheter is withdrawn with
care and the rigid guide-wire is pushed-forward slowly under
fluoroscopic observation (Fig.3a). The bile duct is determined by the
bulging at the closest point on the cut surface. A bile duct orifice
that is wide enough to perform an anastomosis is obtained using cavitron
ultrasonic surgical aspirator to dissect the periductal liver
parenchyma. Following retraction of guide-wire, PTBD catheter was
inserted and HJ anastomosis was performed. In cases that have
external-internal PTBD catheter, it is easy to see the catheter after
the damaged extrahepatic bile duct is explored. In these cases, HJ is
performed over the PTBD catheter and distal end of the catheter was
advanced into the Roux limb (Fig.3b). HJ anastomoses are performed with
interrupted suture using 6/0 monofilament polydioxanone sutures, stiches
remained outside. Following the anastomosis, patency of bile ducts is
controlled with intraoperative cholangiography via PTBD catheter. PTBD
catheters are with-drawn in LLDs without bile leaks on cholangiography
performed on postoperative week 4-6.