Third-Redo Laparoscopic Roux-en-Y Hepaticojejunostomy for Recurrent Anastomotic Stones: A Video-Based Case Report

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Surgery
• Biliary Surgery

Background:

• Redo surgery after Roux-en-Y hepaticojejunostomy presents challenges due to adhesions and altered anatomy.
• Repeated laparoscopic reoperations for recurrent biliary stones are infrequently reported, particularly after multiple revisions.

Purpose of the Study:

• To present technical strategies for a third laparoscopic redo hepaticojejunostomy.
• To highlight the feasibility and critical steps in complex redo biliary surgery.

Main Methods:

• A video-based case report of a 41-year-old woman with recurrent biliary stones after two previous laparoscopic revisions.
• Utilized indocyanine green fluorescence imaging for precise identification of the hepaticojejunostomy.
• Performed meticulous adhesiolysis, stone removal, and reconstruction with a mucosa-to-mucosa technique.

Main Results:

• Successful third laparoscopic redo hepaticojejunostomy was achieved.
• Intraoperative choledochoscopy confirmed complete clearance of intrahepatic bile ducts.
• The patient remained asymptomatic with a patent anastomosis and no stone recurrence at 6-month follow-up.

Conclusions:

• A third laparoscopic redo hepaticojejunostomy is feasible in select patients.
• Adequate anastomotic diameter, careful adhesiolysis, and precise identification are crucial for minimizing recurrence.
• Indocyanine green fluorescence imaging is a valuable tool in complex redo biliary surgery.