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Reproducible Laparoscopic Hepaticojejunostomy Using a Double-Armed Suture Technique Performed by a Procedure-Naïve
Mampei Kawashima1, Yoshiharu Nakamura1, Akira Matsushita2
1Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan.
Asian Journal of Endoscopic Surgery
|February 18, 2026
Summary
A standardized technique for laparoscopic hepaticojejunostomy during minimally invasive pancreaticoduodenectomy (MIPD) proved safe and reproducible for new surgeons. This approach enhances training and the widespread adoption of MIPD.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) is increasingly utilized, but biliary reconstruction, specifically hepaticojejunostomy, presents a significant technical challenge.
- Reproducibility of hepaticojejunostomy by surgeons new to the procedure is a critical concern.
Purpose of the Study:
- To evaluate the safety and reproducibility of a standardized laparoscopic hepaticojejunostomy technique.
- To assess the feasibility of this technique for procedure-naïve surgeons under supervision.
Main Methods:
- Retrospective analysis of 23 patients undergoing MIPD with laparoscopic hepaticojejunostomy.
- Standardized technique using a handmade double-armed suture, performed by a procedure-naïve surgeon under expert supervision.
- Evaluation of anastomotic safety (bile leakage, stricture) and reconstruction time.
Main Results:
- No instances of bile leakage were observed in the 23 patients.
- One patient experienced anastomotic stricture.
- Consistent and minimal variability in reconstruction time indicated stable procedural performance throughout the series.
Conclusions:
- A standardized laparoscopic hepaticojejunostomy technique is safe and reproducible for procedure-naïve surgeons with adequate foundational experience and structured supervision.
- Technique standardization can supplement current surgical training programs and support the broader implementation of MIPD.
