# Successful Laparoscopic Hepaticojejunostomy for Infant Congenital Biliary Dilatation with both Aberrant Right Hepatic Artery and Bile Duct from the Caudate Region

## TL;DR

A 4-month-old infant with a rare biliary condition successfully underwent laparoscopic surgery to correct abnormal bile duct and blood vessel structures.

## Contribution

Demonstrates successful laparoscopic hepaticojejunostomy in a complex infant case with aberrant anatomy.

## Key findings

- Laparoscopic surgery successfully managed biliary dilatation with aberrant right hepatic artery and caudate bile duct.
- Postoperative imaging confirmed no intrahepatic ductal dilatation, indicating successful surgical correction.
- Double-barrel anastomosis technique was effective for connecting the caudate bile duct and main hepatic duct.

## Abstract

A boy with congenital hydronephrosis underwent ultrasonography every month for follow-up. At 4 months of age, ultrasonography incidentally revealed congenital biliary dilatation (5-cm type Ia). We performed laparoscopic extrahepatic bile duct resection and hepaticojejunostomy. After dissecting the dilated common bile duct (CBD), we found that the arcading-like shaped right hepatic artery (RHA) coursed in front of the CBD. Additionally, a tiny duct was identified below the main hepatic duct. At first, we thought it was a lymphatic vessel and dissected it from the main hepatic duct. However, bile flow out was recognized after dissecting the tiny duct. Finally, we confirmed it as an aberrant bile duct from the caudate region. We anastomosed the bile duct from the caudate region and main hepatic duct in a double-barrel fashion and performed hepaticojejunostomy below the RHA. The postoperative course was uneventful. Ultrasonography showed no intrahepatic ductal dilatation including the caudate lobe.