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Roux-en-Y Hepaticojejunostomy (Biliary Bypass)

Reconstruction of bile drainage by anastomosing the common hepatic duct to a defunctionalised jejunal limb.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Roux-en-Y Hepaticojejunostomy (Biliary Bypass)?

Roux-en-Y hepaticojejunostomy is the gold-standard reconstructive technique for restoring bile drainage in conditions where the distal common bile duct is unsuitable or unsafe to anastomose to the duodenum, including iatrogenic bile duct injuries, choledochal cysts, hilar cholangiocarcinoma and after pancreaticoduodenectomy.

The procedure involves dividing the jejunum 30-40 cm from the ligament of Treitz and creating a 60-70 cm defunctionalised Roux limb, which is brought up retrocolically and anastomosed end-to-side to the common hepatic duct or higher biliary confluence.

Long-term outcomes include excellent biliary drainage with low rates of cholangitis, anastomotic stricture (5-10%) and intrahepatic stones; close postoperative follow-up with liver enzymes and imaging is mandatory and percutaneous transhepatic cholangiography may be needed for late strictures.

Symptoms

Iatrogenic bile duct injury after cholecystectomy
Recurrent cholangitis after primary repair
Type I-IV choledochal cyst
Hilar cholangiocarcinoma (Klatskin)
Distal benign biliary stricture
Bile duct injury after liver transplantation
Component of pancreaticoduodenectomy reconstruction

Risk Factors

Iatrogenic injury during laparoscopic cholecystectomy
Choledochal cyst (Todani classification)
Klatskin tumour and biliary malignancy
Primary sclerosing cholangitis with dominant stricture
Recurrent cholangitis with stones
Living donor liver transplantation
Pancreaticoduodenectomy (Whipple) reconstruction

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent jaundice after cholecystectomy
  • Recurrent fever, jaundice and pain (Charcot triad)
  • Bile leak with bilioma
  • Imaging-proven biliary stricture

Treatment Methods

01
MRCP and ERCP for biliary mapping
02
Multidisciplinary HPB surgical assessment
03
Bowel preparation and prophylactic antibiotics
04
Resection of strictured or injured duct segment
05
Construction of 60-70 cm Roux limb
06
Mucosa-to-mucosa hepaticojejunostomy with absorbable sutures
07
Postoperative biliary drain and long-term LFT follow-up

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.