Roux-en-Y Hepaticojejunostomy

Roux-en-Y hepaticojejunostomy (RYHJ) is a surgical procedure that creates a direct anastomosis (connection) between the hepatic bile duct (or biliary confluence) and a defunctioned loop of jejunum — called the Roux limb — that is disconnected from the main bowel continuity and brought up to meet the bile duct. The name "Roux-en-Y" reflects the characteristic Y-shape of the intestinal reconstruction, named after Swiss surgeon César Roux. It is the gold-standard operation for surgical biliary drainage and reconstruction in a wide range of benign and malignant biliary conditions.

The principal indications for Roux-en-Y hepaticojejunostomy include: post-cholecystectomy bile duct strictures (iatrogenic biliary injury — the most common indication), hilar cholangiocarcinoma following resection of the bile duct confluence, Whipple's surgery (pancreaticoduodenectomy) where a hepaticojejunostomy restores biliary drainage after excision of the common bile duct, choledochal cysts following cyst excision, primary sclerosing cholangitis with dominant strictures, and liver transplantation with duct-size discrepancy or diseased recipient duct (as seen in PSC). The anastomosis is performed at the level of the hepatic duct confluence or individual right and left hepatic ducts, depending on the pathology.

The critical technical principles include creating a tension-free, widely patent anastomosis with fine absorbable sutures (PDS 4/0 or 5/0), matching duct-to-bowel mucosa precisely, and ensuring an adequate Roux limb length (at least 60–70 cm) to prevent bile reflux and ascending cholangitis. In complex hilar strictures involving multiple ducts, individual ductoplasties may be required to create a common opening before anastomosis. Long-term outcomes of RYHJ for benign strictures are excellent, with symptomatic success rates of 80–95% at experienced centres. At Ahmedabad Liver Surgeons, our surgical team has extensive experience in complex biliary reconstruction, including reoperative cases and high hilar strictures, achieving durable and reliable outcomes.