Laparoscopic Roux-en-Y Cystjejunostomy and Choledochojejunostomy for a Pancreatic Pseudocyst with Biliary Obstruction

The minimally-invasive management of uncomplicated chronic pancreatic pseudocysts has been shown to be safe and effective with laparoscopy becoming the preferred surgical modality in many patients. Complicated pancreatic pseudocysts, however, continue to pose a challenge to the surgeon, and the ideal surgical treatment remains unclear. We are reporting the first case to our knowledge of a laparoscopic Roux-en-Y cystjejunostomy with choledochojejunostomy for a patient with a pancreatic pseudocyst causing biliary obstruction. The patient is a 57-year-old man who presented with increasing abdominal pain and jaundice. He had a known pancreatic pseudocyst which had increased in size and now demonstrated biliary compression. The patient was taken to the operating room for diagnostic laparoscopy. Decompression of his pseudocyst failed to relieve the biliary obstruction as demonstrated on intraoperative cholangiography. A laparoscopic cystjejunostomy with choledochojejunostomy was successfully performed. The patient was discharged without complication and is doing well in follow-up without recurrence of pain or jaundice. Laparoscopy can be used in the management of select cases of complicated pancreatic pseudocysts. The need for biliary anastomosis should not be considered to be a contraindication to the laparoscopic approach, if appropriate expertise is available.

Session: Video Channel

Program Number: V061

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