Laparoscopic Redo Surgery for Choledochal Cyst with Conversion of Hepaticoduodenostomy to Hepaticojejunostomy

Abstract

Introduction: Laparoscopic redo surgery for late complication after primary surgery for choledochal cyst (ChC) is technically demanding. We report a case with successful laparoscopic redo surgery for ChC. Materials and Methods: A case of laparoscopic redo surgery for late anastomotic stenosis of hepaticoduodenostomy is presented. In this case, laparoscopic conversion of hepaticoduodenostomy to hepaticojejunostomy was performed. Results: The patient was a 12-year-old girl who had ChC type I and underwent laparoscopic excision of ChC and hepaticoduodenostomy 10 years ago. She was asymptomatic till 2015, when she suffered from several attacks of cholangitis and diagnosis of anastomotic stenosis was made by MRI. Percutaneous transhepatic cholangiography was performed with unsuccessful attempt for balloon dilatation of the anastomosis. The patient then underwent laparoscopic redo surgery. Four ports were use in the same positions as the first operation. Laparoscpic exploration showed dense adhesion around the porta hepatis. Careful dissection was performed to expose the hepaticoduodenal anastomosis. After division of the stenotic anastomosis, the duodenal side of the anastomosis was closed by interrupted suture in two layers. Ductoplasty was performed as the hepatic duct is slit in 12 o'clock position for maximal widening of the anastomosis. The Roux-en-Y jejunal loop was created extracorporally through the umbilical incision and was brought up to the hepatic hilum in retrocolic route. Hepaticojejunal anastomosis was performed with running 5.0 PDS suture. Blood loss was minimal. Operative duration was 210 minutes. Patient recovered uneventfully after the operation, started oral feeding on POD 3, and was discharged on POD 5. At follow-up of 6 months, the patient was asymptomatic, with normal liver functional tests, and ultrasonography showed no intrahepatic biliary dilatation. Conclusions: After primary surgery for childhood ChC, laparoscopic redo surgery with conversion of hepaticoduodenostomy to hepaticojenunostomy for late hepaticoduodenal anastomotic stenosis can be feasible and safe at experienced centers. No competing financial interests exist. Runtime of video: 9 mins 44 secs The video was presented at IPEG 27th annual congress, April 11–14, 2018, in Seattle, Washington.