Translaparoscopic jejunal approach for benign stricture of Roux-en-Y hepaticojejunostomy

Although the Roux-en-Y hepaticojejunostomy is the most common surgical procedure for the treatment of bile duct strictures, providing durable long-term results in most patients, when a stricture is present, the management is more difficult, and a reoperation generally will be proposed. However, balloon dilation and endoscopic stenting using the percutaneous transhepatic or transjejunal approach under fluoroscopic guidance have been suggested as the first step or even as definitive management in treating these patients. We present a case report of a patient with a benign biliary stricture as a consequence of a Roux-en-Y hepaticojejunostomy, who was managed through a translaparoscopic jejunal approach because of an unfixed Roux-en-Y loop. In conclusion, we recommend this strategy as the first step for managing the restricture of Roux-en-Y hepaticojejunostomy in patients with an unfixed Roux-en-Y loop.