Alternative Techniques for Hepp-Couinaud Roux-Y Hepatico-Jejunostomy: A Brief Review


Roux-Y Hapatico-Jejunostomy (RYHJ)
Bile Duct Injury (BDI)
Malignant strictures
Benign strictures
Multiple gallstones
Liver transplantation


How to Cite

Coco D, Leanza S. Alternative Techniques for Hepp-Couinaud Roux-Y Hepatico-Jejunostomy: A Brief Review. Integr J Med Sci [Internet]. 2021 Jan. 15 [cited 2022 Jun. 30];8. Available from:


To propose alternative techniques in performing Roux-Y Hapatico-Jejunostomy (RYHJ) during treatment of biliary tree diseases. We have retrospectively evaluated PUBMED articles  to analyze various modified techniques in RYHJ to research an easy technique to log into biliary tree. Modified RYHJ is a safe, feasible and simple technique to permit an alternative method of anastomosis re-esploration.


Dolan JP, Diggs BS, Sheppard BC, Hunter JG. Ten-year trend in the national volume of bile duct injuries requiring operative repair. Surg Endosc. 2005; 19:967.

Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained uring laparoscopic cholecystectomy: perioperative results in 200 atients. Ann Surg. 2005; 241:786.

Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome f biliary reconstruction for bile duct injuries from laparoscopic holecystectomies. Surgery. 2007; 142:450.

Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campbell KA, Tlamini MA, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg. 2000;232:430.

Ludwig K, Bernhardt J, Lorenz D. Value and consequences of routine intraoperative cholangiography during cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2002; 12:154.

Parlak E, Ciçek B, Dişibeyaz S, Cengiz C, Yurdakul M, akdoan M, et al. Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy. Surg Endosc. 2010; 24:466.

Gott PE, Tieva MH, Barcia PJ, Laberge JM. Biliary access procedure in the management of oriental cholangiohepatitis. Am Surg. 1996 Nov;62(11):930–4.

Kassem MI, Sorour MA, Ghazal AH, El-Haddad HM, El-Riwini MT, El-Bahrawy HA. Management of intrahepatic stones: The role of subcutaneous hepaticojejunal access loop. A prospective cohortstudy. Int J Surg. 2014;12(9):886–92.

Beckingham IJ, Krige JE, Beningfield SJ, Bornman PC, Terblanche J. Subparietal hepaticojejunal access loop for the long-term management of intrahepatic stones. Br J Surg. 1998 Oct;85(10):1360–3.

Stiegmann GV, Mansour MA, Goff JS, Pearlman NW. Roux-en-Y jejunoduodenostomy for endoscopic access to hepaticojejunostomy. Surg Gynecol Obstet. 1991 Aug;173(2):153–4.

Sitaram V, Perakath B, Chacko A, Ramakrishna BS, Kurian G, Khanduri P. Gastric access loop in hepaticojejunostomy. Br J Surg. 1998 Jan;85(1):110.

Hamad MA, El-Amin H. Bilio-entero-gastrostomy:Prospective assessment of a modified biliary reconstruction with facilitated future endoscopicaccess. BMC Surg. 2012 Jun 21;12:9.

Moricz Ad, Azevedo OS, Campos TD, Colaiacovo R, Akiba T, Silva RA, et al. Modified “Roux en Y” hepaticojejunostomy to permit transgastric endoscopic access Acta Cir Bras. 2014;29 Suppl 3:14-6.

Saing H, Chan KL, Mya GH, Cheng W, Fan ST, Chan FL, et al. Cutaneous Stoma in the Roux Limb of Hepaticojejunostomy (Hepaticocutaneous Jejunostomy): Useful Access for Intrahepatic Stone Extraction. J Pediatr Surg. 1996 Feb;31(2):247-50.

Michael D. Fung JJ. Intestinal Stomas and Biliary Tree. Atlas of Intestinal Stomas. 2011;111.

Fan ST, Mok F, Zheng SS, Lai EC, Lo CM, Wong J. Appraisal of hepaticocutaneous jejunostomy in the management of hepatolithiasis. Am J Surg. 1993;165(3):332–5.

Moustafa Baiomy, Mohamed Riad, Hassan A. Saad ,Jejunoduodenal anastomosis as permanent biliary access loop post-hepaticojejunostomy: our experience. Interna Surg J. 2019 ; 6 : 9 -3057

Monteiro Cunha JE, Herman P, Machado MC, Penteado S, Filho FM, Jukemura J, et al. A new biliary access technique for the long-term endoscopic management of intrahepatic stones. J Hepatobiliary Pancreat Surg. 2002;9:261–4.

Ramesh H, Prakash K, Kuruvilla K, Philip M, Jacob G, Venugopal B, et al. Biliary access loops for intrahepatic stones: results of jejunoduodenal anastomosis. ANZ J Surg. 2003 May;73(5):306-12.

Abdul Jameel AR, Pitchaimuthu A, Raju P, Shanmugasundaram R, Obla NB, Gounder KD, Hepatico-jejuno-duodenal access loop – a modified biliary reconstruction technique for facilitated endoscopic access to biliary tree following surgery for hepatolithiasis. Int J Hepatobiliary Pancreat Dis. 2018; 8.

Al-Ghnaniem R, Benjamin I. Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury. Br J Surg. 2002;89:1118-24.

Selvakumar E, Rajendran S, Balachandar TG, Kannan DG, Jeswanth S, Ravichandran P, et al. Long-term outcome of gastric access loop in hepaticojejunostomy. Hepatobiliary Pancreat Dis Int. 2008 Apr;7(2):152–5.

Tocchi A, Costa G, Lepre L, Liotta G, Mazzoni G, Sita A. The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. Ann Surg. 1996:224:162–7.

Jabłońska B, Lampe P. Iatrogenic bile duct injuries:etiology, diagnosis and management. World J Gastroenterol. 2009;15:4097–104.

Machado N. Biliary complications postlaparoscopic cholecystectomy: mechanism, preventive measures, and approach to management: a review. Diagn Ther Endosc. 2011;967017.

Csendes A, Navarrete C, Burdiles P, Yarmuch J. Treatment of common bile duct injuries during laparoscopic cholecystectomy:endoscopic and surgical management. World J Surg. 2001;25:1346–51.

Bismuth H, Majno P. Biliary strictures: classification based on the principles of surgical treatment. World J Surg. 2001;25:1241–4.

Koornstra J. Double balloon enteroscopy for endoscopic retrograde cholangiopancreatography after Roux-en-Y construction:case series and review of the literature. Neth J Med. 2008;66:275–9.

Moellmann B, Ruhnke M, Kremer B. Cholangioduodenal interposition of an isolated jejunal segment after central resection. Hepatobiliary Pancreat Dis Int. 2004;3:259–64.

Jayasundara J, De Silva W, Pathirana A. Therapeutic value and outcome of gastric access loops created during hepaticojejunostomy for iatrogenic bile duct injuries. Surgeon. 2010;8:325–9.

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