P Senthilnathan, R Parthasarathi, S Rajapandian, P Praveen Raj, Anand Vijai, V P Nalankilli, G Srivatsan, Sandeep Sabnis, C Palanivelu. GEM Hospital & Research Centre
After pancreaticoduodenectomy surgery hepaticojejunostomy (HJ) stricture is a rare condition and seen in undilated ducts. Usually, management is conservative while operative revision is only rarely performed and by doing laparoscopically is even rarer.
Case details: A 14 year old girl presented with recurrent fever with chills for 3 month. She underwent laparoscopic pylorus preserving pancreaticoduodenectomy one year back for solid pseudopapillary neoplasm of head of pancreas. She had recurrent cholangitis warranting hospital admissions. Her Ultrasonography showed dilated intrahepatic billiary radicle with common hepatic duct (CHD -1.5cm). She was optimised and planned for laparoscopic assisted endoscopic dilatation of hepaticojejunostomy stricture.
Operative procedure: Pneumoperitoneum was created, 4 ports introduced. Omental adhesion over HJ released and HJ stricture noted. Efferent jejunal limb identified, enterotomy made for endoscopic passage. Occlusive, impassable tight HJ stricture noted as guide wire could not be negotiated beyond stricture. Hence laparoscopic stricturoplasty planned. Enterotomy made near to HJ on efferent limb. Dilated CHD confirmed with aspiration of bile and opened in contiguity with enterotomy. The common vertical opening was sutured in horizontal fashion ensuring wide stoma. Postoperatively, drain tube removed and patient discharged on third postoperative day
Conclusion: In inaccessible or failed endoscopic management of HJ stricture, surgical revision of HJ strictures can be safely performed by an experienced pancreatic surgeon with a low morbidity without mortality. Laparoscopic approach can be tried in specialised centre with expert surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80846
Program Number: V060
Presentation Session: Friday Exhibit Hall Video Presentations Session 1 (Non CME)
Presentation Type: EHVideo