Long term biliary access by modified hepaticojejunostomy for high bile duct stricture

Area of Science:

• Hepatobiliary Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Recurrent high bile duct strictures present significant management challenges.
• Standard hepaticojejunostomy offers limited long-term access for managing biliary strictures.
• Benign hepatic duct strictures require effective, repeatable interventions.

Purpose of the Study:

• To present a modified hepaticojejunostomy technique for recurrent high bile duct strictures.
• To evaluate the feasibility of retaining long-term access for future interventions.
• To improve management strategies for benign biliary strictures.

Main Methods:

• A modified hepaticojejunostomy was performed on six patients with benign hepatic duct strictures.
• A longer Roux-en-Y loop was utilized, with hepatic ducts anastomosed 10-15 cm from the jejunal free end.
• Silastic tubes were placed through the anastomosis into hepatic ducts, exiting the jejunum for access.

Main Results:

• The modified technique successfully retained safe access via the Silastic tubes.
• Future endoscopic or radiological access was feasible through the retained Roux loop.
• No complications related to the retained access tubes were reported in this small cohort.

Conclusions:

• This modified hepaticojejunostomy provides durable, long-term access for managing benign high bile duct strictures.
• The technique facilitates repeat interventions, such as balloon dilatation or further investigations.
• This approach offers a valuable solution for patients with complex biliary strictures requiring ongoing management.