Hepaticojejunostomy: Purpose, Procedure, Benefits and Side Effects

Hepaticojejunostomy is a surgical procedure that involves connecting the end of the small intestine (jejunum) to the liver (hepatic) to allow bile to flow from the liver into the intestine.

• End-to-End anastomosis: This is the most common type of hepaticojejunostomy. It involves connecting the end of the hepatic duct to the end of the jejunal loop.
• Side-to-Side anastomosis: This type of hepaticojejunostomy involves connecting one side of the hepatic duct to one side of the jejunal loop.
• Roux-en-Y Hepaticojejunostomy: This type of hepaticojejunostomy involves creating a Y shape by connecting two sides of the hepatic duct to two sides of the jejunal loop, creating a Y shape formation.

• Reduction of Pressure in Bile Ducts: The main benefit of hepaticojejunostomy is that it helps reduce the pressure in the bile ducts by allowing the bile to drain directly from the liver into the intestine. Pain, jaundice, and nausea brought on by biliary blockage may be lessened as a result.
• Improved Liver Function: Another benefit of hepaticojejunostomy is that it can improve overall liver function by allowing bile to flow more freely and reduce pressure on the liver. This can improve symptoms associated with liver damage, such as fatigue and abdominal swelling.
• Improved Quality of Life: Lastly, hepaticojejunostomy can improve a person's quality of life by relieving symptoms associated with biliary obstruction and improving overall liver function. This can lead to improved energy levels, better appetite, and potentially fewer hospital visits or medications for management of symptoms.

Hepaticojejunostomy is typically done to treat bile duct abnormalities or blockages that are caused by conditions such as primary sclerosing cholangitis, biliary atresia, trauma, or tumours.

Moreover, it may be used to alleviate the side effects of biliary tract conditions such as gallstones.

By connecting the hepatic ducts with the jejunum, bile can drain more efficiently and avoid accumulating in the liver. This reduces inflammation and helps improve overall health.

• Bleeding: Due to the manipulation of the organs and veins during the procedure, bleeding is a possibility. This can be managed by using sutures and pressure to control bleeding.
• Infection: There is also a risk of infection due to the introduction of foreign objects into the body, such as catheters, wires, or surgical instruments. To minimise this risk, antibiotics are typically given prior to and after the procedure.
• Leaks: Another potential complication is leakage from the anastomosis (connection) between the jejunum and liver. This may result in fluid buildup in the abdominal cavity, infection, or abdominal discomfort (ascites). To prevent this complication, surgeons usually use multiple layers of sutures when creating the anastomosis.
• Adverse reactions to anaesthesia: There is also a risk of an adverse reaction to anaesthesia during surgery which can result in nausea, vomiting, difficulty breathing, or even death in rare cases.

• Hepaticojejunostomy preparation involves a complete physical and medical history evaluation. This covers liver and other organ system evaluations. To confirm the diagnosis and choose the appropriate surgery, ultrasound, CT scan, and MRI may be ordered.
• Blood tests, including complete blood count, coagulation studies, liver function tests, and serum electrolytes should be done prior to surgery in order to assess the patient’s condition.
• A discussion with a nutritionist is recommended to ensure that the patient is well-nourished prior to surgery.
• The patient should be instructed on various post-operative precautions such as not driving for at least one week after surgery and avoiding certain activities that may put strain on their abdominal muscles.
• The patient should also follow instructions from their doctor regarding any medications or supplements they need to take before and after the procedure, as well as any dietary changes they need to make in order to ensure a successful outcome from their hepaticojejunostomy procedure.

• During the procedure, the surgeon will make an incision into the abdomen and locate the bile duct and small intestine.
• The surgeon will then carefully stitch together the two organs so that bile can flow freely from the liver into the intestine.
• Once this connection has been made, the surgeon will close up the incision and place a drain tube in order to remove any excess fluid from around the area of surgery.
• After surgery, patients may experience some discomfort and swelling which should improve with time and medications prescribed by their doctor.

• Diagnostic evaluation of the patient by physical examination, laboratory tests and imaging studies.
• Preoperative preparation such as fasting and administration of antibiotics as prescribed.
• Preparation of the operating room including appropriate monitoring equipment, instrumentation and staff.
• Intraoperative preparation for the procedure such as positioning, skin preparation and draping of the patient in a sterile fashion.
• Administration of general anaesthesia and intubation for patient comfort during the procedure.

• After opening the abdomen, the gallbladder will need to be divided in order to access the common bile duct.
• The hepatic artery and portal vein are identified and a Roux-en-Y loop of jejunum is brought up to the hilum of the liver.
• The common bile duct is divided close to its origin, and a Roux-en-Y loop of jejunum is then brought up to the cut end of the bile duct.
• The jejunum loop is then anastomosed to both sides of the cut ends of the common bile duct using a running suture technique or stapling device.
• Care must be taken to ensure that there are no leaks or strictures in the anastomosis before closure of the abdomen.

• Patient is shifted to the recovery room and monitored for any complications.
• Checkups at regular intervals are performed in order to monitor how well the surgical wound is healing.
• The patient is asked to restrict physical activities until full recovery.
• Dietary changes are suggested to reduce the stress on the newly connected organs.
• Medications are prescribed to reduce swelling, pain, and infection risk if any.
• Follow-up appointments with the doctor are scheduled for further evaluations and tests.

The price of a hepaticojejunostomy in India varies according on the facility and doctor you choose, the intricacy of the treatment, and other factors. Hepaticojejunostomies typically cost between Rs. 1,50,000 and Rs. 2,00,000 ($2,000 to $2,500 USD) in India.

• High Protein Foods: Lean meats, poultry, fish, eggs, dairy products, and legumes are examples of foods rich in protein that are crucial for supplying the body with nutrients following a hepaticojejunostomy.Protein helps the body to repair damaged tissue and helps to prevent infection.
• Complex Carbohydrates: The body receives energy and fibre from complex carbs found in foods including whole grains, fruits, vegetables, and legumes. Fibre supplies vital vitamins and minerals and aids in maintaining a healthy digestive tract.
• Healthy Fats: Good fats that are vital for healing after a hepaticojejunostomy, such as olive oil, avocados, nuts, and seeds, aid to minimise inflammation.
• Low-Fat Dairy Products:After a hepaticojejunostomy, low-fat dairy products like yoghurt, kefir, or cottage cheese are a healthy source of calcium, which is crucial for bone health.
• Water: Consuming plenty of water keeps the body hydrated, which is crucial for recovery after surgery.

Yes, hepaticojejunostomy is generally a safe procedure when performed by a qualified surgeon. This surgery has a number of hazards, including bleeding, infection, and harm to surrounding organs.

Yes, hepaticojejunostomy is a major abdominal surgery that can be quite painful. Pain relief medications and other treatments may be needed to help manage the pain afterwards.

The recovery time for a hepaticojejunostomy depends on the individual, but typically it takes between 4-6 weeks for the incision to heal and 3-6 months for a full recovery.

• The most common side effect of hepaticojejunostomy is an infection. This can manifest as fever, abdominal pain, and/or nausea.
• Another possible side effect is biliary stricture, which occurs when the bile ducts become blocked due to scarring or inflammation caused by the surgery. Jaundice, stomach discomfort, and weight loss may result from this.
• Bowel obstruction is another potential complication of hepaticojejunostomy surgery. This can occur when scar tissue forms around the new bile duct connection and prevents the flow of food or bile through the bowel. Symptoms include nausea, vomiting, abdominal pain, and constipation.
• Bleeding can also occur in the area where the new connection was made between the liver and small intestine. If not treated very once, this might result in significant consequences including shock or even death.
• Other possible complications include pancreatitis, hernia formation at the surgical site, and malnutrition due to malabsorption of nutrients in food due to blockage of bile flow in the small intestine caused by hepaticojejunostomy surgery

• Drink plenty of fluids: This will assist in keeping the body hydrated, preventing dehydration, and eliminating any toxins.
• Eat a healthy diet: Eating a balanced diet high in fibre, low in fat and full of essential nutrients can help to ensure proper healing after the surgery.
• Get adequate rest: It is important to get adequate rest to allow the body to recover from surgery and heal properly.
• Follow doctor's instructions: Following all of the doctor's instructions is essential for proper healing and recovery following hepaticojejunostomy surgery. This entails following your doctor's instructions on dosage and attending follow-up visits.
• Avoid strenuous activity: It is important to avoid any strenuous activity or heavy lifting for at least two weeks after surgery to give your body time to heal properly.
• Monitor for signs of infection: Pay attention for any signs of infection, such as fever or pain, redness or swelling at the incision site, and contact your doctor if you experience any of these symptoms.

Hepaticojejunostomy is a surgical procedure that involves connecting the end of the small intestine (jejunum) to the liver (hepatic) to allow bile to flow from the liver into the intestine.