Standard bilioenteric anastomosis

The gold standard in bilioenteric anastomosis is retrocolic end-to-side Roux-en-Y hepaticojejunostomy with a segment of the proximal jejunum.

Here, the preferred bilioenteric anastomosis is established proximal to the cystic duct and about 2-3 cm distal to the union of the hepatic ducts.

• The opening of the anastomosis should be as wide as possible (if the common hepatic duct is too small it may be enlarged with the Hepp-Couinaud technique)
• The single row of interrupted suture encompassing all layers should be leak-roof from the beginning and
• precisely adapt the mucosa of the hepatic duct to that of the jejunum.

The anastomosis will be explained as part of the Whipple procedure for cancer of the pancreatic head. One modification of the bilioenteric anastomosis (hilar hepatojejunostomy) is found under Hepp-Couinaud technique for bilioenteric anastomosis,

In the hepatoduodenal ligament expose the proper hepatic artery, portal vein and the CHD / CBD. Free the entire circumference of the duct.