Laparoscopic Roux-en-Y hepaticojejunostomy as an acute treatment of a right posterior hepatic duct injury: a case report

Abstract

Background Laparoscopic cholecystectomy (LC) remains as the gold standard of surgical treatment for gallstone disease. Biliary duct injury (BDI) is an infrequent but serious complication of LC. Strasberg's critical view is a useful strategy to minimize the risk of a BDI. However, BDIs could still happen. Variations of the right posterior hepatic duct (RPHD) are common. The surgical treatment of RPHD injury is challenging and literature on this matter is scarce. Case summary Aberrant drainage of the right posterior hepatic duct (RPHD) into the gallbladder neck was unexpectedly identified in a 43-year-old man during laparoscopic cholecystectomy. Intraoperative consultation with a specialized Hepatobiliary surgeon was accomplished and a laparoscopic anastomosis between the RPHD and the jejunum with a Roux-en-Y reconstruction was carried out. The operation was uneventful with no long-term complication reported over a 12-month follow-up period. Conclusion Aberrant implantation of the RPHD into the gallbladder neck must be borne in mind despite its low incidence. Previous studies reporting the management of this injury are scarce. In our case, a laparoscopic Roux-en-Y hepaticojejunostomy with the RPHD by an experienced HPB surgeon was a successful strategy to solve this difficult case.