Perioperative management - Hepp-Couinaud bilioenteric anastomosis - general and visceral surgery
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- Reinsertion of the bile ducts after resection of the pancreatic head.
- Bilioenteric bypass in unresectable neoplastic obstructions of the bile ducts and papilla.
- Iatrogenic injury to the CBD
- Congenital and acquired bile duct stenosis
- Significant comorbidity with unfitness for anesthesia and/or surgery
Preoperative diagnostic work-up
Following iatrogenic bile duct injury, e.g., during laparoscopic cholecystectomy, the preoperative diagnostic work-up requires vascular imaging (CT-/MRI-angiography) as well as bile duct imaging (ERCP/MRCP).
General risks of surgery
- Vascular/nerve injury
- Secondary bleeding
- Injury to adjacent organs
Special aspects of informed consent
- Dehiscent suture with biliary leaks
- Late sequela of stenosis with intermittent cholangitis
Operating room setup
Special instruments and fixation systems