Anastomosis, Roux-en-Y, of intrahepatic biliary ducts and gastrointestinal tract
CPT4 code
Name of the Procedure:
Anastomosis, Roux-en-Y, of intrahepatic biliary ducts and gastrointestinal tract
(Common name: Roux-en-Y biliary anastomosis; Technical term: Hepaticojejunostomy with Roux-en-Y)
Summary
The Roux-en-Y biliary anastomosis is a surgical procedure that connects the intrahepatic bile ducts inside the liver to a part of the small intestine called the jejunum. This allows for bile to flow directly from the liver into the intestines, bypassing any blockages or damaged sections.
Purpose
This procedure addresses blockages, strictures, or damage to the bile ducts, usually from conditions like bile duct cancer, strictures, gallbladder removal complications, or congenital abnormalities. The goal is to restore normal bile flow, reduce symptoms like jaundice and pain, and prevent liver damage.
Indications
- Jaundice due to bile duct obstruction
- Bile duct strictures or injuries
- Biliary duct cancers
- Previous gallbladder surgery complications
- Congenital bile duct anomalies
- Pancreatitis-related bile duct issues
Preparation
- Fasting for at least 8 hours before the surgery
- Discontinuation of certain medications as advised by the doctor
- Preoperative imaging (e.g., MRI, MRCP) to visualize the biliary and gastrointestinal anatomy
- Blood tests to assess liver function and clotting factors
Procedure Description
- Patient receives general anesthesia.
- An incision is made in the abdomen to access the liver and intestines.
- The surgeon isolates the intrahepatic bile ducts and a segment of the jejunum.
- A Roux-en-Y limb of the jejunum is created by dividing the intestine and forming a Y-shaped configuration.
- The limb is then brought up and connected (anastomosed) to the bile ducts.
- The connection is secured, and the abdominal incision is closed.
Tools: Scalpel, sutures, laparoscopic instruments (if performed minimally invasively), surgical staplers.
Anesthesia: General anesthesia is used to ensure the patient is unconscious and pain-free during the procedure.
Duration
The procedure typically takes 3 to 4 hours, depending on the complexity.
Setting
Performed in a hospital operating room.
Personnel
- Surgeon specializing in hepatobiliary surgery
- Surgical nurse
- Anesthesiologist
- Operating room technician
- Possibly an assistant surgeon
Risks and Complications
- Infection
- Bleeding
- Bile leakage
- Stricture or narrowing of the anastomosis
- Injury to surrounding organs
- Anesthesia-related complications
Benefits
- Restoration of bile flow
- Reduction or elimination of jaundice
- Pain relief
- Prevention of further liver damage
- Improved digestion
Benefits are typically realized shortly after recovery from surgery.
Recovery
- Hospital stay of about 5 to 7 days
- Pain management with medications
- Gradual reintroduction of diet
- Monitoring of liver function tests
- Avoiding strenuous activities for 4 to 6 weeks
- Follow-up visits for postoperative assessment
Alternatives
- Endoscopic biliary stenting (temporary)
- Percutaneous transhepatic biliary drainage
- Liver transplant (in specific, severe cases)
Pros and cons depend on the patient's underlying condition and overall health, with the Roux-en-Y providing a more permanent solution but requiring major surgery.
Patient Experience
During the procedure: Patient will be under general anesthesia and unaware of the procedure.
After the procedure: Expect incision site pain, managed with medication. Gradual improvement in symptoms like jaundice and pain over the recovery period. Monitoring for potential complications is important.