In the Hepp-Couinaud hepaticojejunostomy deep in the hepatic hilum, the efferent jejunal limb is anastomosed with the extrahepatic left hepatic duct side-to-side. This type of biliodigestive anastomosis deep in the hepatic hilum is indicated in stenoses extending to the junction of the left and right hepatic ducts, but where the common hepatic duct is still intact.
Otherwise, the surgical technique is identical with Standard bilioenteric anastomosis.
- The goal is to fashion as wide an anastomotic opening as possible.
- The single row of interrupted suture encompassing all layers should be leak-proof from the beginning.
- Precisely adapt the mucosa of the hepatic duct to that of the jejunum.