Hepaticojejunostomy Periprocedural Care

Updated: May 26, 2017
  • Author: Fazia Mir, MD; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Preprocedural Planning

Right-upper-quadrant ultrasonography is a useful preoperative study to look for biloma or fluid collections. Computed tomography (CT) can help delineate intra-abdominal structures and anatomy. Magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) is also useful to help with identifying the remaining biliary anatomy. Such imaging shows the surgeon where the injury or lesion is and helps in preoperative planning.

If the patient has a biliary disruption from injury or complete obstruction, interventional radiology can be called upon to perform a percutaneous transhepatic cholangial drainage (PTCD), which helps decompress the biliary system and can be useful for preoperative imaging of the anatomy.

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Patient Preparation

Anesthesia

General anesthesia is recommended for patients undergoing a biliary bypass procedure. Spinal anesthesia can be a helpful adjunct in some cases, especially for postoperative pain control.

Positioning

Typically, the patient should be supine on the operating table. The arms may be tucked or not, depending on the individual surgeon's preference. Enough room should be available to allow placement of a self-retaining retractor.

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