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Single-incision versus conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for children with choledochal cysts: a case-control study.
The main hepatic duct that is required to dissect right above the cystic duct, was dissected after the fusion (Figure 1), and continuity was provided with hepaticojejunostomy. The patient was discharged without any postoperative complications on day 8.
A year later, the patient presented with obstructive jaundice for which he underwent hepaticojejunostomy. He again developed an infected pseudocyst, which was drained percutaneously with a 18 F catheter.
Radical cholecystectomy with enbloc resection of bile duct, portal lymphadenectomy with roux-en-y hepaticojejunostomy was done.
One year ago, he was diagnosed with cholangiocarcinoma, and underwent uncomplicated right trisegmentectomy, resection of extrahepatic biliary tree, and complete portal lymphadenectomy, with Roux-en-Y hepaticojejunostomy to 2 intrahepatic ducts.
The patient underwent a common bile duct resection, cholecystectomy, and Roux-en-Y hepaticojejunostomy. The mass was completely removed and sent to pathology for confirmatory diagnosis.
The patients are supposed to be recommended with surgery which includes transduodenal operative approach repaired, sphincteroplasty, T-tube drainage, and even hepaticojejunostomy within 24 h when initial endoscopic and conservative management did not yield good results.
The hepaticojejunostomy was completed with 4/0 PDS (Ethicon[R]) continuous suture (Figure 3b).
Patients having a history of undergoing hepaticojejunostomy, choledochoduedenostomy, CBD exploration and any other extrabiliary surgical procedure along with cholecystectomy were also excluded from the study.
Till today the procedure of choice is hepaticojejunostomy. We propose to introduce a new technique: fistula-enteric anastomosis, which has significant advantages as compared to the standard hepaticojejunostomy procedures.
The preferred method of biliary tract reconstruction at our center is "duct-to-duct" anastomosis, and hepaticojejunostomy was not performed in patients with rare indications and biliary tract complications.