An improved laparoscopic choledochojejunostomy technique (with video)

Abstract

Choledochojejunostomy is an important procedure in hepatobiliary pancreatic surgery. It is used in pancreaticoduodenectomy, biliary strictures, liver transplantation, and other surgical reconstructions involving bile duct resection. Safe and reliable anastomosis under laparoscopic guidance is important for good postoperative recoveries. There are some difficulties owing to the limited angle of laparoscopic instruments. Standardized anastomosis methods are currently lacking, especially for cases with thin bile duct walls and small diameters. We modified the traditional laparoscopic choledochojejunostomy by combining the advantages of interrupted and continuous sutures using continuous sutures of the posterior and anterior walls followed by intermittent knot-tying of the anterior walls. The technical aspects of this anastomosis method and the related experiences of high-volume centers are summarized. An experienced laparoscopic surgeon can safely perform laparoscopic choledochojejunostomy by following a programmed anastomosis procedure. This modified anastomotic technique simplifies the procedure, reduces the difficulty of laparoscopic anastomosis, and yields satisfactory results. Larger-scale studies are necessary to validate whether it can definitively reduce complications and enhance outcomes.