Related Experiment Video
Updated: Mar 28, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Recurrence of biliary tract obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal
Mei Diao1, Long Li2, Wei Cheng3,4
1Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, 100020, People's Republic of China.
Insights
Recurrent biliary obstructions after laparoscopic surgery for choledochal cysts (CDC) can stem from aberrant hepatic arteries or poor anastomotic technique. Early surgical correction is crucial to prevent liver damage and restore normal liver function.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Choledochal cyst (CDC) management often involves hepaticojejunostomy.
- Recurrent biliary obstructions can occur post-primary laparoscopic hepaticojejunostomy in pediatric CDC patients.
- Identifying causes and management strategies for these obstructions is critical.
Purpose of the Study:
- To investigate the causes of recurrent biliary obstructions after primary laparoscopic hepaticojejunostomy in children with CDC.
- To develop effective management strategies for these complex cases.
- To evaluate the outcomes of redo hepaticojejunostomy with potential ductoplasty and aberrant vessel repositioning.
Main Methods:
- Retrospective analysis of 30 pediatric patients with CDC experiencing recurrent biliary obstructions post-laparoscopic hepaticojejunostomy.
- Patients underwent redo hepaticojejunostomy, with options for ductoplasty and repositioning of aberrant right hepatic arteries.
- Assessment of pre- and post-operative liver function, liver biopsy for fibrosis, and surgical outcomes during follow-up.
Main Results:
- Aberrant right hepatic arteries crossing the common hepatic duct were identified as a novel cause in 23.3% of patients.
- Hepatic duct strictures (30%) and anastomotic strictures (46.7%) were other significant causes.
- Redo surgery resulted in no recurrent biliary obstruction or cholangitis, with normalized liver function after a median follow-up of 62 months.
Conclusions:
- Aberrant hepatic arteries, unresolved hepatic duct strictures, and suboptimal anastomotic techniques are key contributors to post-hepaticojejunostomy biliary obstructions.
- Prompt surgical intervention is recommended to mitigate liver damage and improve patient outcomes.
- Redo hepaticojejunostomy, addressing specific causative factors, offers a successful management strategy.
Background:
The aim of the current study was to investigate the cause and develop a management strategy for recurrent biliary obstructions after primary laparoscopic hepaticojejunostomy in children with choledochal cyst (CDC).
Methods:
Thirty CDC patients (mean age: 7.15 years, range 8 months-24 years, F/M: 22/8) who suffered from recurrent biliary obstructions after primary laparoscopic hepaticojejunostomies were referred to our hospital between January 2006 and June 2014. All patients underwent redo hepaticojejunostomy ± ductoplasty ± reposition of aberrant right hepatic arteries.
Results:
All patients developed recurrent cholangitis or persistent abnormal liver function 1 month to 7 years postoperatively. Liver biopsy pathology verified that 56.7 % (17/30) of patients had grades I-IV of liver fibrosis. We identified a previously unreported cause of biliary obstruction, i.e., aberrant right hepatic arteries crossing anteriorly to the proximal common hepatic duct in high percentage of the patients who suffered from postoperative recurrent biliary obstructions (7/30, 23.3 %). The hepatic arteries were repositioned behind Roux loop during the redo hepaticojejunostomies. Of remaining patients, nine (30 %) patients had associated hepatic duct strictures and underwent ductoplasties and wide hepaticojejunostomies. Fourteen (46.7 %) patients had anastomotic strictures and underwent redo hepaticojejunostomies. The median follow-up period was 62 months (14-115 months). No recurrent biliary obstruction or cholangitis was observed up to date. Liver functions were normalized.
Conclusions:
Aberrant hepatic artery, unsolved hepatic duct stricture, as well as poor anastomotic technique, can all contribute to recurrent biliary obstructions after the primary laparoscopic hepaticojejunostomies. Early surgical correction is advocated to minimize liver damage.
More Related Videos
07:36Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
07:48Intraoperative Video Consultation Following Bile Duct Transection Facilitates Direct OR Transfer for Robotic Hepaticojejunostomy at Tertiary Center
Published on: January 9, 2026