Anastomosis technique, biliodigestive, classical

The end-to-side hepaticojejunostomy with a retrocolically routed upper jejunal loop excluded from the passage by Roux-Y anastomosis represents the gold standard of biliodigestive anastomosis.
In this case, the biliodigestive anastomosis is preferably created above the cystic duct insertion and approx. 2–3 cm below the hepatic bifurcation.

• The widest possible anastomosis opening should be created (if the bile duct is too narrow, widening procedures are recommended, e.g. after Hepp-Couinaud).
• The suture with single-row full-thickness interrupted sutures should be primarily watertight.
• An exact adaptation of bile and intestinal mucosa must be aimed for.

The anastomosis is explained in the context of a Whipple operation for pancreatic head carcinoma. A variant of the biliodigestive anastomosis (hilar hepatojejunostomy) can be found under Anastomosis technique, biliodigestive, according to Hepp-Couinaud.

In the area of the hepatoduodenal ligament, the proper hepatic artery, portal vein, and the common bile duct or hepatic duct are displayed. The bile duct itself is circumferentially dissected.