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Annals of Surgical Oncology

, Volume 21, Issue 6, pp 1841–1843 | Cite as

Totally Laparoscopic Right Hepatectomy with Roux-en-Y Hepaticojejunostomy for Right-Sided Intraductal Papillary Mucinous Neoplasm of the Bile Duct

  • Marcel Autran MachadoEmail author
  • Fabio F. Makdissi
  • Rodrigo C. Surjan
Hepatobiliary Tumors

Abstract

Background

Intraductal papillary neoplasm of the bile duct is a precursor lesion of cholangiocarcinoma. We present a video of a totally laparoscopic right hepatectomy with hilar dissection and lymphadenectomy, en-bloc resection of the extrahepatic bile duct, and Roux-en-Y hepaticojejunostomy in a patient with intraductal papillary neoplasm of the right hepatic duct.

Methods

A 58-year-old woman with right upper quadrant pain was referred for evaluation. Abdominal ultrasonography revealed dilatation of intrahepatic and extrahepatic bile ducts. Magnetic resonance imaging showed a stop in the right bile duct, with dilatation of the distal bile duct. The decision was to perform a totally laparoscopic right hepatectomy with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy.

Results

The operative time was 400 min. Estimated blood loss was 400 ml, without the need for transfusions. Postoperative recovery was uneventful, and the patient was discharged on the 10th postoperative day. The abdominal drain was removed on the 14th postoperative drain with no signs of biliary leakage. Final pathology confirmed the diagnosis of intraductal papillary neoplasm without malignant transformation. Surgical margins were free. Patient is well with no evidence of the disease 14 months after the procedure.

Conclusions

Laparoscopic right hepatectomy with hepaticojejunostomy is feasible and safe, provided it is performed in a specialized center and with staff with experience in hepatobiliary surgery and advanced laparoscopic surgery. Currently this operation is reserved for selected cases. This video can help oncologic surgeons to perform this complex procedure.

Keywords

Bile Duct Cholangiocarcinoma Hepatic Duct Intraductal Papillary Mucinous Neoplasm Extrahepatic Bile Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

Drs. Machado, Makdissi and Surjan have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 106047 kb)

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Marcel Autran Machado
    • 1
    Email author
  • Fabio F. Makdissi
    • 1
    • 2
  • Rodrigo C. Surjan
    • 1
    • 2
  1. 1.Department of SurgerySirio Libanes HospitalSão PauloBrazil
  2. 2.Department of GastroenterologyUniversity of São PauloSão PauloBrazil

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