Laparoscopic extended right hepatectomy, portal lymphadenectomy, and hepaticojejunostomy for hilar cholangiocarcinoma.

Abstract

BACKGROUND:

Laparoscopic-assisted extended hepatectomy and laparoscopic hepaticojejunostomy reconstruction can be performed for hilar cholangiocarcinoma by combining our existing protocols for laparoscopic anatomic hepatectomy and laparoscopic hand-sewn bilio-enteric anastomosis.

SUBJECTS AND METHODS:

Our first patient was a 42-year-old man with cholangitis and jaundice from tumor obstructing the hepatic duct bifurcation who underwent a right extended hepatectomy for hilar cholangiocarcinoma (Bismuth IIIa), radical portal lymphadenectomy, and Roux-en-Y hepaticojejunostomy using laparoscopic techniques. A four-trocar, one 6-cm wound protector laparoscopic technique was used. Inflow and outflow exclusion was achieved first, followed by liver transection. Radical portal lymphadenectomy was performed. A Roux-en-Y hepaticojejunostomy was constructed laparoscopically. We have performed three other cases using the same technique: two requiring right extended hepatectomy and one requiring left extended hepatectomy.

RESULTS:

No intraoperative complications occurred during the 4.0-hour procedure. Tumor margins were clear. The patient was given oral diet on Day 1 and discharged on Day 3 after surgery. No blood transfusions were necessary. A cholangiogram performed 10 days after surgery demonstrated patent hepaticojejunostomy, and magnetic resonance imaging performed during week 3 demonstrated the normal caliber of the intrahepatic biliary system. At 6 months, the patient was completely without symptoms and exhibited normal liver function tests.

CONCLUSIONS:

Laparoscopic-assisted right extended hepatectomy for hilar cholangiocarcinoma with laparoscopically hand-sewn hepaticojejunostomy in select patients can be achieved with good outcomes.

• Authors: Edward Lin, Juan M Sarmiento
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 24 Issue 6 Pg. 411-6 (Jun 2014) ISSN: 1557-9034 [Electronic] United States
• PMID: 24784226 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Anastomosis, Roux-en-Y
• Bile Duct Neoplasms (pathology, surgery)
• Bile Ducts, Intrahepatic (pathology, surgery)
• Biliary Tract Surgical Procedures
• Cholangiocarcinoma (pathology, surgery)
• Hepatectomy (adverse effects, methods)
• Humans
• Jejunum (surgery)
• Laparoscopy (adverse effects, methods)
• Liver (surgery)
• Lymph Node Excision (adverse effects, methods)
• Male