Hepaticoduodenostomy in Hepatectomy for Perihilarcholangiocarcinoma: A Preliminary Report

A Roux?en?Y anastomosis fashioned from the jejunum (i.e., hepaticojejunostomy) is usually used to reconstruct the biliary system in hepatectomy. In this study, we review our experience with hepaticoduodenostomy (HD) as an alternative to Roux?en?Y biliary anastomosis in patients undergoing hepatectomy for perihilarcholangiocarcinoma, report our preliminary findings in 2 patients, and speculate on future applications. Laparotomy was performed using a Kent retractor. Wide kocherization of the duodenum was done to provide a tension?free anastomosis to the hepatic duct. The Kent retractor was released transiently, and the anastomosis was confirmed to be free of tension. Hepatectomy and excision of the common bile duct were performed. In patients with short distances between the hepatic ducts, a hepaticoplasty was performed. A 10?Fr silicon drain with channels along the sides, approximately 20 mm in length, was used as an internal stent. HD was performed with a single?layer anastomosis with continuous sutures. No complication occurred after HD. Our initial experience suggests that HD may be a viable alternative to Roux?en?Y biliary anastomosis in patients undergoing hepatectomy for perihilarcholangiocarcinoma.