Understanding Roux-en-Y Hepaticojejunostomy (RYHJ)

RYHJ is done to fix a block or injury in the biliary system. Many things can cause such a problem, including:

• Noncancer (benign) or cancer tumors in the bile ducts
• Liver cancer
• Cysts
• Gallbladder disease
• Chronic pancreatitis
• Infection in the bile duct system
• An injury during surgery to take out the gallbladder

To get ready for this surgery:

• Tell your healthcare provider what medicines you take. Include both prescription and over-the-counter medicines. Also include vitamins, herbs, and supplements.
• Have any tests your provider asks for, such as blood tests. You may also need imaging tests like an abdominal ultrasound or a CT or MRI scan. These help your provider better see where the blockage or injury is.
• Follow any directions you're given for not eating or drinking before your surgery. You may need to take some medicine with sips of water. Talk with your healthcare provider.
• You'll be asked to sign an informed consent form. Signing the form means you understand the surgery. It means you agree to the procedure. Be sure all your questions are answered before you sign the form.

This surgery takes place in a hospital. During it:

• An IV (intravenous) line will be put into a vein in your arm or hand. It gives you fluids and medicine to prevent pain. You'll get general anesthesia. This puts you into a deep sleep during the surgery.
• Your healthcare provider will make a cut (incision) in your belly (abdomen). They will then find the blockage or injury in the bile duct system.
• Your provider will make a cut in the side of jejunum. They will sew the end of the hepatic duct to the side of the jejunum.
• They may place a small mesh tube called a stent into the end of the hepatic duct to keep it open.
• They will check for any bile duct leaks.
• When finished, your provider will remove all tools from your abdomen and close the incision with stitches (sutures) or staples.
• They may place a small tube (drain) in your abdomen. This drain removes any excess blood or fluid. It may stay in place for a few days after the surgery. In some cases you will go home with this drain. If this happens, you will be taught to care for the drain.

You’ll be taken to a recovery room to rest. When you’re awake and alert, you’ll be moved to a regular hospital room. You’ll be given medicines to help manage pain and prevent infection. You may also be given medicine and special stockings or boots to wear to help prevent blood clots. As soon as you’re able, you’ll need to stand and walk for short periods. A nurse or therapist will help you.

You may have a nasogastric (NG) tube. This tube is placed in your nose and goes down into your stomach to help drain stomach acid. You’ll receive IV fluids until you can start on a liquid diet. You’ll then slowly return to your normal diet. Follow your healthcare team’s specific diet instructions. You may be taught coughing methods and breathing exercises to help keep your lungs clear.

Your healthcare provider will tell you when it’s OK for you to go home. Keep all follow-up visits with your provider. Talk with your provider if you have any questions or concerns.

All procedures have risks. The risks of RYHJ include:

• Bleeding
• Bile leaking
• Infection
• Inflammation of the bile duct
• Narrowing of the bile duct
• Pooling of bile in the abdomen
• Liver failure

Call if you have:

• Shortness of breath
• Trouble breathing

Call your healthcare provider if any of these occur:

• Yellowing of your eyes or skin (jaundice)
• Fever of 100.4°F (38.0°C) or higher, or as advised by your provider
• Chills
• Redness or swelling of the incision
• Fluid leaking or a bad smell from the incision
• Incision pain that gets worse
• Dark or rust-colored urine
• Stool that is light in color instead of brown
• Increasing belly pain
• Rectal bleeding
• Leg swelling