Left Lateral Sectionectomy With Intrahepatic Cholangiojejunostomy for Portal Cavernoma Cholangiopathy (PCC)—A Novel Approach

Abstract

The development of portal cavernoma cholangiopathy (PCC) in cases of extrahepatic portal vein obstruction (EHPVO) presents significant management challenges. Strictures, stones, and extensive collaterals at the porta hepatis contribute to considerable surgical complexity. The traditional surgical approach for such patients involves a portosystemic shunt, followed by hepaticojejunostomy when indicated. In carefully selected cases, left lateral sectionectomy combined with intrahepatic cholangiojejunostomy (Longmire’s procedure) offers a viable and durable long-term solution. We present two cases where this approach was successfully employed. Both the patients had sub-hilar strictures, and a large stone burden localized to the left lateral section of the liver. Conventional hepaticojejunostomy was contraindicated due to a heavily collateralized hilum, which precluded a safe landing zone. In these two cases, left lateral sectionectomy was performed to clear the large intrahepatic stone burden, with intrahepatic cholangiojejunostomy providing effective biliary drainage while avoiding the heavily collateralized hilar and pericholedochal regions.