Laparoscopic Roux-en-Y hepaticojejunostomy for post-cholecystectomy type IIIb benign biliary stricture with internal duodenal fistula: A case report with surgical video.

Abstract

Abstract: Laparoscopic cholecystectomy (LC) is a widely performed procedure, but it can be complicated by iatrogenic bile duct injuries, leading to benign biliary strictures (BBS). This report details the case of a 38-year-old man with a Bismuth type IIIb BBS and an internal duodenal fistula following LC. He underwent a totally laparoscopic Roux-en-Y hepaticojejunostomy (RYHJ), a technically demanding procedure, particularly in the presence of complex biliary strictures. The surgery involved meticulous dissection and the creation of a wide hepaticojejunostomy. The patient had an uneventful recovery, with discharge on the post-operative day 4. At 18-month follow-up, he remains asymptomatic with normal liver function. This case demonstrates the feasibility and effectiveness of laparoscopic RYHJ in managing complex BBS, offering the advantages of minimally invasive surgery, including reduced post-operative pain and shorter hospital stay, while ensuring favourable long-term outcomes.