Korean J Hepatobiliary Pancreat Surg.  2016 May;20(2):66-70. 10.14701/kjhbps.2016.20.2.66.

Cluster hepaticojejunostomy with radial spreading anchoring traction technique for secure reconstruction of widely opened hilar bile ducts

• Hwang S
• Ha TY
• Song GW
• Jung DH

• KMID: 2243017
• DOI: http://doi.org/10.14701/kjhbps.2016.20.2.66

Abstract

Secure reconstruction of multiple hepatic ducts that are severely damaged by tumor invasion or iatrogenic injury is a challenge. Failure of percutaneous or endoscopic biliary stenting requires lifelong placement of one or more percutaneous transhepatic biliary drainage (PTBD) tubes. For such difficult situations, we devised a surgical technique termed cluster hepaticojejunostomy (HJ), which can be coupled with palliative bile duct resection. The cluster HJ technique consisted of applying multiple internal biliary stents and a single wide porto-enterostomy to the surrounding connective tissues. The technique is described in detail in the present case report. Performing cluster HJ benefits from three technical tips as follows: making the multiple bile duct openings wide and parallel after sequential side-to-side unification; radially anchoring and traction of the suture materials at the anterior anastomotic suture line; and making multiple segmented continuous sutures at the posterior anastomotic suture line. Thus, cluster HJ with radial spreading anchoring traction technique is a useful surgical method for secure reconstruction of severely damaged hilar bile ducts.

Keyword

Cluster hepaticojejunostomy; Perihilar cholangiocarcinoma; Bile duct injury; Percutaneous transhepatic biliary drainage; Radial spreading anchoring traction

MeSH Terms

Bile Ducts*
Bile*
Connective Tissue
Drainage
Hepatic Duct, Common
Stents
Sutures
Traction*

Figure

• 

  Fig. 1 Surgical procedures of cluster hepaticojejunostomy. The hilar tumor was removed (A) and multiple intrahepatic bile duct openings were exposed with insertion of stent tubes (B). The anterior wall of the bile duct opening was anchored with multiple 5-0 Prolene sutures (C). The posterior wall of the bile duct opening was segmented into 3 parts by two internal intervening sutures (D); these intervening sutures were tied (E); and completed the posterior wall anastomosis (F). During the posterior wall suturing, each corner stitch was retracted with a rubber vessel loop to widen the operative field. Five internal stents were firmly inserted into each bile duct opening, and separately transfixed with 5-0 Prolene suture (G). The anterior wall was finally closed with interrupted sutures (H).

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