Long term biliary access by modified hepaticojejunostomy for high bile duct stricture.

Patients with recurrent high bile duct strictures pose special problems for management. Relief of obstruction by hepaticojejunostomy is usually possible but the standard technique does not permit long term access. Six patients with benign strictures involving hepatic ducts have been treated by a simple modification of hepaticojejunostomy retaining access for either balloon dilatation of intrahepatic strictures or investigation and treatment at a later stage if problems recur. Employing a longer than usual Roux-en-Y loop, the sutured anastomosis of right and left hepatic ducts is performed 10-15 cm from the free end of jejunum. Silastic tubes are placed into each hepatic duct crossing the anastomosis to exit from the free end of the jejunum which is closed around the tubes. The closed end of jejunum is buried in the peritoneum deep to linea alba and the tubes emerge in the epigastrium. Safe access is retained via the tubes. If the tubes are removed, a 'mini-lap' will expose the Roux loop for endoscopic or radiological access.