Annals of Hepato-Biliary-Pancreatic Surgery

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Fig. 2.

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Fig. 2. Intraoperative photograph showing the procedure of side-to-end choledochojejunostomy with intraluminal closure of the distal common bile duct (CBD) in Case No. 1. (A) The dilated CBD is visible after cholecystectomy. (B) The mid-portion of the CBD is incised longitudinally, showing markedly thickened CBD wall indicating repeated episodes of cholangitis. (C) The distal CBD is explored with curved stone forceps to examine the opening status of the sphincter. (D, E) The lumen of the distal CBD at the upper board of the pancreas is securely closed with 5-0 Prolene running sutures twice. The suture knots are made at the outer surface of the CBD (arrow). A part of the anterior wall of the CBD is excised to widen the opening. (F-H) A Roux-en-Y jejunal limb is anastomosed to the CBD opening in a side-to-side fashion.
Ann Hepatobiliary Pancreat Surg 2021;25:259-64
© 2021 Ann Hepatobiliary Pancreat Surg