Advances in Minimally Invasive Diagnosis and Treatment Procedures for Pancreaticobiliary Maljunction: A Narrative Review.

BACKGROUND

Pancreaticobiliary maljunction (PBM) is a congenital anomaly characterized by an abnormal union of thepancreatic and bile ducts outside the duodenal wall, leading to uncontrolled bidirectional refl ux and a markedlyelevated lifetime risk of biliary tract cancer. Prophylactic surgery is therefore indicated, with management evolvingfrom open resection to minimally invasive approaches.

OBJECTIVE

This narrative review aims to summarize the current evidence, technical evolution, clinical outcomes, andfuture perspectives of minimally invasive diagnosis and treatment for PBM, with emphasis on laparoscopic androbotic‑assisted surgery, endoscopic interventions, and the necessity of lifelong surveillance.

METHODS

A comprehensive literature search was performed in PubMed, Embase, Cochrane Library, Web of Science,and Scopus for articles published between January 1995 and May 2026, using relevant MeSH terms and keywords.Included studies comprised original research, systematic reviews, meta‑analyses, and clinical guidelines. Data weresynthesized narratively, with priority given to comparative studies and large series from high‑volume centers.

RESULTS

Laparoscopic complete extrahepatic bile duct excision with Roux‑en‑Y hepaticojejunostomy has become thegold standard for PBM with congenital biliary dilatation, off ering equivalent oncological outcomes to open surgerybut with signifi cantly less blood loss, shorter hospital stay, and faster recovery. Robotic‑assisted surgery providesenhanced dexterity and visualization, reducing bile leak rates and conversion to open surgery, albeit with longeroperative times and higher costs. Endoscopic interventions (sphincterotomy, common‑channel sphincterotomy) arevaluable as defi nitive therapy in high‑risk surgical patients or as bridging therapy. For isolated PBM without biliarydilatation, the optimal extent of resection remains debated, with cholecystectomy alone or prophylactic bile ductexcision individualized based on age and risk profi le. Long‑term surveillance is mandatory due to persistentlow‑grade malignancy risk in residual epithelium.

CONCLUSIONS

Minimally invasive approaches have transformed PBM management, establishing laparoscopy asstandard for dilated cases and robotics as a powerful adjunct for complex anatomies. Endoscopic therapy has adefi ned role in select patients. Future advances will likely include molecular risk stratifi cation and artifi cialintelligence‑enhanced imaging. Lifelong structured surveillance remains imperative for all patients, regardless ofsurgical strategy.