Redo laparoscopic Roux-en-Y hepaticojejunostomy for recurrent benign biliary strictures after failed primary anastomosis: technical nuances and mid-term outcomes.

BACKGROUND

Recurrent benign biliary strictures after failed hepaticojejunostomy remain a major surgical challenge, particularly in East Asia. This study aimed to evaluate the feasibility and mid-term outcomes of a structured, risk-adapted protocol for redo laparoscopic Roux-en-Y hepaticojejunostomy (RYHJ).

METHODS

Between June 2019 and December 2024, 26 consecutive patients underwent redo laparoscopic RYHJ performed by a single surgeon. Patients were preoperatively stratified according to the Hobson adhesion grade (I-V) into low-risk (I-II), moderate-risk (III), and high-risk (IV-V) groups. In patients classified as high risk, a standardized intraoperative strategy incorporating indocyanine green (ICG) fluorescence cholangiography via pre-established percutaneous transhepatic cholangiodrainage and refined anastomotic techniques was applied. Key operative steps were prospectively video documented. Primary and secondary endpoints included technical success, perioperative outcomes, and biliary patency during follow-up.

RESULTS

Redo laparoscopic reconstruction was successfully completed in all patients. The median operative time was 210 min (range 150-378) and median blood loss was 55 mL (range 10-200).Patients with higher Hobson grades demonstrated increased technical complexity and a higher incidence of early postoperative bile leakage. In the final six high-risk cases, no bile leaks or anastomotic strictures were observed during a median follow-up of 36 months, despite increased operative complexity.

CONCLUSIONS

Redo laparoscopic RYHJ using Hobson-guided protocols yielded durable mid-term outcomes with acceptble morbidity. In high-risk patients, the standardized use of ICG fluorescence and refined anastomotic techniques contributed to improved safety, representing a reproducible and clinically practical technical refinement for complex redo biliary surgery.