Minimally Invasive Approach of Bile Duct Stricture after Laparoscopic Hepatectomy.

INTRODUCTION

Extragonadal germ cell tumors in pediatric patients are rare, accounting for approximately 10 to 15% of all germ cell tumors. High-risk chemotherapy followed by surgical resection represents the standard of care. Post-hepatectomy biliary complications, such as hepatic duct stenosis, constitute a relevant clinical challenge.

CASE PRESENTATION: We present the case of a 10-year-old pediatric patient with a retroperitoneal and mediastinal extragonadal germ cell tumor treated with high-risk chemotherapy according to the GALOP 2017 protocol and multiple surgical procedures, including laparoscopic atypical left hepatectomy for residual disease. The patient subsequently developed stenosis of the main hepatic duct. Percutaneous biliary drainage and balloon cholangioplasty were performed, successfully restoring biliary patency and normalizing liver function tests, without immediate complications.

DISCUSSION: Post-hepatectomy biliary complications in pediatric patients, although uncommon, may be related to mechanical trauma or metallic clip placement. Percutaneous management is effective and safe, allowing avoidance of open reintervention. Multidisciplinary planning is essential to optimize outcomes in high-risk pediatric germ cell tumors.

CONCLUSION

Post-hepatectomy biliary stenosis should be considered in pediatric patients presenting with jaundice and cholestasis. Percutaneous management of biliary complications is a safe and effective alternative, highlighting the importance of early intervention and close follow-up to preserve liver function.