Anastomosis technique, biliodigestive, according to Hepp-Couinaud

In the high-hilar Hepatico-Jejunostomy according to Hepp-Couinaud, the anastomosis of the Roux jejunal loop with the extrahepatic left hepatic duct is performed side-to-side. This high form of biliodigestive anastomosis is chosen for strictures that extend to the bifurcation but with preserved confluence.
Otherwise, the surgical technique is similar to the anastomosis technique, biliodigestive, classic.

• A wide anastomotic opening should be created as much as possible.
• The suture with single-layer full-thickness interrupted sutures should be primarily tight.
• An exact adaptation of the bile and intestinal mucosa must be aimed for.

In the area of the hepatic hilum, the proper hepatic artery as well as the right and left hepatic arteries are exposed. The bile duct itself is circumferentially dissected free.

After circular dissection of the bile duct, the transection of the hepatic duct is performed in the area of the liver hilum. Here, the two lumina of the right and left hepatic ducts can already be visualized. A segment of the bile duct is removed, and the duodenal end of the common bile duct is oversewn with a continuous suture (Vicryl® 3-0) (not shown). In the area of the transected hilar bile duct, subtle hemostasis is performed if necessary with 6-0 PDS.

Due to the expected anastomosis shrinkage, an extension of the left bile duct according to Hepp-Couinaud must be performed. This is done by a longitudinal incision of the anterior wall of the left hepatic duct. Extension of the confluence by resection of the dorsal spur and suturing of the posterior wall.