Laparoscopic hepaticojejunostomy (HJ) enterotomy, stone extraction and laser lithotripsy post-childhood Roux-En-Y HJ...

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Surgical Techniques
• Biliary Tract Interventions

Background:

• Roux-En-Y hepaticojejunostomy (REY HJ) is used for choledochal cysts but can lead to complications.
• De novo choledocholithiasis and hepaticojejunostomy strictures present therapeutic challenges after REY HJ.
• Conventional endoscopic retrograde cholangiopancreatography (ERCP) is often ineffective due to altered anatomy.

Purpose of the Study:

• To report the successful use of intraoperative laser lithotripsy (LL) in a patient with de novo choledocholithiasis and HJ stricture.
• To evaluate LL as a complementary technique for managing bile duct stones in complex biliary anatomy.
• To demonstrate the feasibility of laparoscopic management for choledocholithiasis post-REY HJ.

Main Methods:

• A case presentation of a patient with intrahepatic choledocholithiasis and HJ stricture two decades after REY HJ.
• Laparoscopic exploration and intraoperative laser lithotripsy (LL) for stone fragmentation and clearance.
• Surgical management facilitated by LL, allowing for successful laparoscopic completion.

Main Results:

• Intraoperative laser lithotripsy effectively fragmented and cleared bile duct stones.
• The laparoscopic surgery was completed successfully without significant postoperative complications.
• Follow-up evaluations confirmed sustained clearance of bile duct stones.

Conclusions:

• Intraoperative laser lithotripsy is a viable and effective complementary technique for managing de novo choledocholithiasis and HJ strictures.
• Laparoscopic exploration, lithotripsy, and stone extraction are feasible options in selected cases with altered biliary anatomy.
• LL facilitates successful surgical management in patients with challenging post-REY HJ complications.