Background : Laparoscopic pancreaticoduodenectomy (PD) is one of the most technically challenging procedures to be done minimally invasive. A technically sound hepatico-jejunostomy (HJ) forms an integral part of the reconstruction and biliary leaks complicate around 2 to 3% of PD. In this video, we demonstrate our technique of performing a laparoscopic HJ with posterior continuous and anterior interrupted sutures.

Methods : The anastomosis is single-layered layered, and we begin by taking a stay stitch at the farther corner. The posterior continuous sutures are then taken with the same suture used for the stay, always starting with the bowel and then taking the bile duct to ensure good visualisation of the mucosa when taking the sutures. On reaching the other corner, an interrupted stitch is taken, and the posterior layer is ended by tying off with the interrupted suture. Anterior interrupted sutures are then taken to complete the anastomosis. ArtiSential was used for anterior stitches as the articulation provided additional degrees of freedom and increased the ease of suturing. The anastomosis was done using Vicryl.

Results : The anastomosis took around 40 minutes to complete. The patient had a smooth post-operative recovery and was discharged on POD 8.

Conclusions : Laparoscopic Hepatico-jejunostomy performed with a standardised, replicable technique provides a safe and comfortable method for a technically challenging anastomosis.