47780 Anastomosis, Roux-en-Y, of extrahepatic biliary ducts and gastrointestinal tract

Name of the Procedure:

Anastomosis, Roux-en-Y, of Extrahepatic Biliary Ducts and Gastrointestinal Tract

• Common Names: Roux-en-Y Hepaticojejunostomy

Summary

This surgical procedure connects the bile ducts leading from the liver to the small intestine, enabling bile to bypass any blockages or damaged sections. It forms part of the digestive process and helps maintain normal bile flow into the gastrointestinal tract.

Purpose

• Medical Condition Addressed: Obstructed or damaged extrahepatic bile ducts, commonly due to cancer, scarring, or other diseases.
• Goals/Outcomes: To restore bile flow from the liver to the small intestine, improving digestion and alleviating symptoms such as jaundice and pain.

Indications

• Symptoms like jaundice, abdominal pain, or severe itching due to blocked bile ducts.
• Conditions such as strictures, bile duct injuries, or biliary cancers.
• Patients with biliary atresia or chronic pancreatitis affecting bile flow.

Preparation

• Instructions: Patients may need to fast for 8-12 hours before surgery.
• Medications: Some medications might need to be adjusted or stopped prior to the procedure.
• Diagnostics: Pre-operative imaging like MRCP (Magnetic Resonance Cholangiopancreatography) or ERCP (Endoscopic Retrograde Cholangiopancreatography) and general health assessments.

Procedure Description

1. Anesthesia: General anesthesia will be administered.
2. Incision: A surgical incision is made in the abdomen.
3. Isolation: The bile ducts are identified and isolated from any obstructed or damaged segments.
4. Connection: A loop of the small intestine (jejunum) is divided and brought up to create a 'Y'-shaped connection.
5. Anastomosis: The bile ducts are connected to the jejunum to form a new pathway for bile flow.
6. Closure: The surgical site is closed with sutures.

• Tools: Scalpel, surgical staplers, sutures, and other standard surgical instruments.

Duration

Typically, the procedure lasts between 3 to 5 hours.

Setting

Performed in a hospital operating room.

Personnel

• Surgeons specialized in gastrointestinal or hepatobiliary surgery.
• Nurses and surgical technicians.
• Anesthesiologists.

Risks and Complications

• Common Risks: Infection, bleeding, or bile leakage.
• Rare Complications: Stricture formation at the anastomosis site, liver dysfunction, or long-term digestive issues.
• Management: Post-operative monitoring and appropriate surgical or medical interventions as needed.

Benefits

• Restored Bile Flow: Significant improvement in bile flow and relief from related symptoms.
• Symptom Relief: Reduction in jaundice, abdominal pain, and digestive issues.
• Long-term Outcome: Improved quality of life and liver function.

Recovery

• Care Instructions: Pain management, wound care, and activity restrictions.
• Recovery Time: Varies but generally 4-6 weeks before resuming normal activities.
• Follow-up: Regular medical check-ups to monitor recovery and bile duct function.

Alternatives

• Non-surgical options: Endoscopic stenting or percutaneous drainage.
• Pros and Cons: Endoscopic methods are less invasive but may be temporary. Surgery offers a more permanent solution but with higher risks.

Patient Experience

• During: The patient will be under general anesthesia, so won't feel pain during the procedure.
• After: Expect some post-operative pain, typically managed with pain medications. Gradual improvement is expected, and following care instructions will help ensure a smooth recovery.