Hepatico-Jejunostomy During Pancreatic Surgery Is a Safe Teaching Procedure for Young Trainees: A Multivariable Analysis

Background The reconstructive phase of pancreatic surgery may be suitable for teaching young general surgery trainees in performing hepatico-jejunostomy (HJ). Aims Describe the technique, and the results of HJ in a teaching hospital. Methods Retrospective analysis of consecutive pancreatoduodenectomy (PD) and total pancreatectomy (TP) from 01/2016 to 10/2025. The primary outcome was a composite-endpoint of HJ-related morbidity (primary biliary leak, cholangitis/sepsis or abscess, HJ stenosis) in HJ performed by seniors vs. trainees. Cox regression analysis was used to assess the predictors of HJ-related complications including teaching among covariates. Results During 150 pancreatic resections (PD=145; TP=5), 115 HJ (76.7%) were taught to a total of 22 trainees of postgraduate year≥4 (mean HJ number=5.2 per trainee). Patient baseline and bile ducts characteristics were similar for seniors vs. trainees. A single-layer HJ with 5-0 or 6-0 absorbable monofilament was performed in all cases, using interrupted sutures in 86%. After a median follow-up of 20.3 months (IQR 8.4-39.5), HJ-related morbidity rate was 10.0% (cholangitis 8.7%, biliary leak, abscess and stenosis 0.67% each). HJ-related morbidity was 11.4% vs. 9.6% for the seniors vs. the trainees respectively (p=0.751), without differences in biliary leaks, cholangitis, abscesses, nor stenosis (all p>0.05). Percutaneous biliary drainage was needed in 2 cases (1.3%), and surgical reintervention in 2 (1.3%). For redo-surgery, 1 was due to primary biliary leak successfully managed using a trans-anastomotic T-tube, the other was conversion of HJ to a Roux-en-Y loop due to persistent biliary reflux and recurrent cholangitis 1-year after PD. In both cases HJ was performed by a senior surgeon. Overall, HJ-related reinterventions were similar for seniors vs. trainees (5.7% vs 1.7%; p=0.232). Redo-HJ was never necessary. Cox regression analysis showed that the cumulative-risk of HJ-related morbidity was not impacted by teaching. Conclusion Respecting the technical principles of HJ ensures the feasibility and safety of teaching bilioenteric reconstruction during pancreatic surgery.