Peripheral hepatojejunostomy for unresectable malignant biliary obstruction: is it still a valid strategy?

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Peripheral hepatojejunostomy (HJ) is infrequently performed.
• It may provide durable internal biliary drainage for unresectable hilar or intrahepatic malignancy.
• Securing biliary continuity is crucial when resection is abandoned.

Purpose of the Study:

• To evaluate the validity of peripheral HJ as an option for internal biliary drainage.
• To detail indications, technique, and short-term outcomes.
• To assess HJ in patients whose curative resection was abandoned intraoperatively.

Main Methods:

• Retrospective analysis of 20 patients between 2010 and 2024.
• HJ constructed to drain segmental intrahepatic ducts after resection abandonment.
• Data collected on preoperative biliary interventions, operative technique, perioperative outcomes, and follow-up.

Main Results:

• 20 patients (median age 71) underwent HJ; 50% had bilateral HJ.
• No intraoperative deaths; 90-day mortality was 15%.
• Overall morbidity was 50% (20% major complications); median survival was 8 months.

Conclusions:

• Peripheral HJ remains a selective option for internal biliary drainage when resection is abandoned.
• It offers durable palliation, reducing reliance on external drainage and interventions.
• The technique warrants reconsideration in selected contemporary practice settings.