Complex biliary reconstruction: Hepatico-jejunostomy with 3 hepatic ducts

Liver Transection and Biliary Reconstruction Techniques

Overview of Hepaticogastrostomy

• The video introduces the technique of hepaticojejunostomy, a common approach for biliary reconstruction in patients undergoing liver transection with resection of the hepatic ducts.

Suture Placement Technique

• A method is described where all posterior wall sutures are completed first before moving to the anterior row, allowing for precise placement without interference from the intestine.

• Stay sutures are utilized to hold open the anterior walls of multiple ducts, facilitating easier access for posterior suture placements.

Enterotomy and Suture Management

• An enterotomy on the jejunum is performed, followed by placing interrupted sutures on the posterior wall of all three ducts.

• Attention is given to maintaining a clear view during suture placements; distances between enterotomies are carefully measured to avoid tension in reconstruction.

Finalizing Anastomosis

• The jejunum is positioned down towards duct orifices, with posterior wall sutures tied inside. The anterior row of sutures completes the anastomosis with knots secured outside.