Rethinking biliary reconstruction: alternatives to standard Roux-en-Y hepaticojejunostomy

Roux-en-Y hepaticojejunostomy enables tension-free bile-duct reconstruction and minimizes reflux. However, factors like a short mesentery or severe peri-hilar inflammation may prevent the jejunal loop from reaching the hepatic hilum, making safe anastomosis unfeasible. We have developed a novel surgical technique that overcomes these challenges. In this case report, we describe our triple bypass technique, in which a vascularized gastric tube graft is anastomosed to the common bile duct, and we present short-term outcomes from the use of this technique in a patient with chronic pancreatitis; overall, this patient recovered well, with a viable graft and no leakage. This novel technique expands surgical options for complex extrahepatic bile-duct reconstruction.