Biliary reconstruction with Roux-en-Y hepaticojejunostomy

The most common reconstruction for proximal bile duct injury is Roux-en-Y hepaticojejunostomy. Biliary stent placement helps reduce stricture at the anastomosis. Once a silastic stent has been positioned to replace the prior drainage catheter, the small bowel is divided and the distal small bowel (Roux limb) brought up and sutured to the bile duct (end-to-side hepaticojejunostomy). An end-to-side bowel-bowel anastomosis completes the Roux-en-Y reconstruction.