Hepaticojejunostomy without suture

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Innovation
• Minimally Invasive Techniques

Background:

• Standard 'a la Roux' hepaticojejunal anastomosis is challenging with narrow or thin common bile duct (CBD) stumps.
• Poor anatomical conditions, often seen in iatrogenic or malignant CBD lesions, complicate traditional sutured anastomosis.
• Existing methods may be insufficient when biliary stump quality compromises suture integrity.

Observation:

• A novel sutureless hepaticojejunal anastomosis technique was developed.
• This method utilizes a Foley-type balloon catheter to stent and maintain apposition of anastomosis segments.
• Continuous traction on the catheter facilitates healing over an average of 10 days.

Findings:

• The sutureless technique was successfully applied in 7 cases of CBD stenosis (4 neoplastic, 3 accidental lesions).
• The procedure demonstrated no perioperative morbidity in the treated cases.
• One fatal outcome was recorded, necessitating further evaluation.

Implications:

• This sutureless method offers a viable alternative for hepaticojejunal anastomosis in challenging CBD anatomies.
• It may reduce complications associated with suturing in compromised biliary stumps.
• Further research is warranted to validate the safety and efficacy of this technique in a larger cohort.