Laparoscopic Roux-en-Y side-to-side hepaticojejunostomy for inoperable carcinoma of pancreas (Video)

Abstract

Background: Biliary reconstruction is a common procedure for both benign disease (e.g. choledocholithiasis, choledochal cyst) as well as malignant biliary obstruction. However, it remains a challenging procedure when performed with laparoscopic approach. Methods: We performed laparoscopic Roux-en-Y side-to-side hepaticojejunostomy and gastrojejunostomy using 3D laparoscope for a 66-year old lady who suffered from carcinoma of pancreas with liver and portal lymph node metastasis. Patient was placed in the supine position with legs apart and a 15◦ head up tilt. Five trocars of 5-12mm were used. Roux-en-Y hepaticojejunostomy was fashioned in a side-to-side manner with continuous suture. Results: The operative time was 280 minutes and blood loss was 50ml. Patient was able to resume diet on postoperative day 2 and she was transferred to convalescent hospital on day 5. Conclusion: Laparoscopic biliary reconstruction is technically demanding and the use of the 3D laparoscope could help to overcome some of the difficulties associated with the procedure. Side-to-side hepaticojejunostomy is technically feasible and can be considered for those patients with portal lymph node involvement which made hilar dissection difficult.