Application of multiple Roux-en-Y hepaticojejunostomy reconstruction by formation of bile hilar duct lake in the operation of hilar cholangiocarcinoma

Figure 1 Bile duct lake formation model. A: Three of the adjacent bile ducts were formed into a bile duct lake. bc, de, and af are the adjacent bile duct septum incision lines cut to o; B: Suturing with 5-0 Prolene continuous sutures after adjacent bile duct incision. The adjacent edges, including bo and co, do and eo, and ao and fo, were continuously sutured to point o; C: Bile duct lake formation completed.

Figure 2 Intraoperative photographs. A: Complete vascular skeletonization of the hepatoduodenal ligament, including groups 12a, b, c, h, p, 7, 8a, p, 9, and 11d; B: Radical resection and lymphadenectomy of hilar lesion R0 were completed; eight bile duct ends appeared on the remnant hepatic surface of the hilar region, which were hepatic segment ducts, including hepatic segments II, III, and IV; V, VII, and I; and VI and VII; C: Formation of bile duct lake was completed. Hepatic segments II, III, and IV; V, VIII, and I; and VI and VII were used to form a bile duct lake; D: Three of the end-to-side Roux-en-Y hepaticojejunostomy reconstructions by formation of bile duct lake were completed; E: Formation of a bile duct lake was completed using 5-0 Prolene continuous sutures; F: Two of the bile duct lake-forming jejunal end-to-side anastomosis were completed.

Figure 3 Survival curve.