47760 Anastomosis, of extrahepatic biliary ducts and gastrointestinal tract

Name of the Procedure:

Anastomosis of Extrahepatic Biliary Ducts and Gastrointestinal Tract
Common name: Biliary-enteric anastomosis
Medical term: Hepaticojejunostomy or Choledochojejunostomy

Summary

In this surgical procedure, a connection is created between the bile ducts outside the liver and a part of the gastrointestinal tract, usually the small intestine. This allows bile to flow directly from the liver into the intestines, bypassing any obstruction.

Purpose

The procedure addresses obstructions or blockages in the biliary ducts, which may be caused by conditions such as tumors, strictures, or gallstones. The goal is to restore the normal flow of bile into the intestines, which helps in digestion and prevents bile from backing up into the liver, thus preventing liver damage.

Indications

• Persistent jaundice due to bile duct obstruction
• Severe biliary strictures
• Bile duct tumors
• Chronic pancreatitis
• Injuries to the bile ducts

Preparation

• Fasting for at least 8 hours before surgery
• Preoperative blood tests, imaging studies like ultrasound, CT scan, or MRI
• Possibly stopping certain medications as advised by the healthcare provider
• Enema or bowel preparation if instructed

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an abdominal incision to access the biliary ducts and part of the small intestine (typically the jejunum).
3. The extrahepatic bile duct is dissected and prepared.
4. A segment of the jejunum is brought up and anastomosed (surgically connected) to the bile duct using sutures.
5. The connection is checked for patency and leaks.
6. The incision is closed, and a drain may be placed to prevent fluid accumulation.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• General or Hepatobiliary Surgeon
• Anesthesiologist
• Surgical Nurse
• Operating Room Technician

Risks and Complications

• Infection
• Bleeding
• Bile leak
• Anastomotic stricture or failure
• Injury to surrounding organs
• Postoperative jaundice
• Peritonitis

Benefits

• Relief of jaundice and symptoms of bile duct obstruction
• Prevention of liver damage
• Improved digestion and absorption of dietary fats

Recovery

• Hospital stay of about 5-7 days
• Pain management with medications
• Gradual reintroduction of diet
• Instructions on wound care and activity limitations
• Follow-up appointments for sutures/drains removal and assessment
• Full recovery usually takes about 4-6 weeks

Alternatives

• Endoscopic stenting of biliary ducts
• Percutaneous transhepatic biliary drainage
• Liver transplantation (in severe cases)

Pros of alternatives:

• Minimally invasive options like stenting offer quicker recovery
• Less risk of major surgery complications

Cons of alternatives:

• Temporary solutions may require repeat procedures
• Not suitable for all conditions, like large tumors or extensive strictures

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Postoperatively, the patient might experience:

• Mild to moderate pain managed with medications
• Soreness at the incision site
• Fatigue and need for rest
• Gradual return to normal diet and activities Pain management will be an integral part of the recovery process, and patients will receive instructions on how to keep comfortable.