Laparoscopic hepaticojejunostomy (HJ) enterotomy, stone extraction and laser lithotripsy post-childhood Roux-En-Y HJ for type 1 choledochal cyst.

De novo choledocholithiasis and hepaticojejunostomy stricture in patients with previous Roux-En-Y hepaticojejunostomy (REY HJ) pose a therapeutic challenge as conventional methods like endoscopic retrograde cholangiopancreatography are rendered ineffective due to anatomical alterations.We present a case of a patient with de novo choledocholithiasis 2 decades after a previous common bile duct excision, REY HJ for type 1 choledochal cysts, performed when she was 2 weeks old. She presented with dyspepsia and cholestatic liver function tests and was noted to have HJ stricturing with intrahepatic choledocholithiasis. The use of intraoperative laser lithotripsy (LL) facilitated fragmentation and clearance of bile duct stones, allowing for surgery to be completed successfully laparoscopically. She had no significant postoperative complications, and follow-up evaluations confirmed sustained stone clearance.This article reports the outcomes of LL as a complementary technique. Laparoscopic exploration, lithotripsy and stone extraction are viable options in selected cases.