Introduction : Hepaticojejunostomy (HJ) is one of the common surgical procedures in hepatobiliary and pancreatic (HBP) surgery to treat both benign and malignant diseases. There were few studies in which an attempt has been made to describe the detailed procedure of HJ.

Methods : The total of 128 operations were performed. Most of the patients had recurrent pyogenic cholangitis (RPC) and had undergone Roux-en-Y HJ with permanent access. Anastomosis was done with both extrahepatic and intrahepatic bile duct. Construction of HJ was performed by detailed step-by-step method. PDS or Vicryl suture was used. The size of suture depends on the opening of the anastomosis. The anastomosis was made using interrupted stitches for the anterior layer and continuous fashion posteriorly. For special consideration, mucosal stitches and vertical incision to CHD were performed for smaller anastomosis, and in multiple bile duct openings, neighboring bile ducts were transformed into a common channel by inserting stitches between them.

Results : There were three mortalities in the study. All cases were associated with major bile leak. Two patients had RPC with cholangitic abscess. The other patient had periampullary CA who had undergone Whipple’s operation. Six patients had minor bile leak that recovered with conservative treatment.

Conclusions : In this paper, the proposed method for HJ is a reliable and feasible technique. It can be applied in a variety of diseases. The method is not a recommendation or procedural modification but a useful surgical option which follow the standard principles of anastomosis.