Third-Redo Laparoscopic Roux-en-Y Hepaticojejunostomy for Recurrent Anastomotic Stones: A Video-Based Case Report.

BACKGROUND Redo surgery after Roux-en-Y hepaticojejunostomy is technically demanding due to dense intra-abdominal adhesions and distorted anatomy. Repeated laparoscopic reoperations for recurrent biliary stones remain rarely reported, especially in patients undergoing multiple revisions. This study presents a video-based case highlighting technical strategies for a third laparoscopic redo hepaticojejunostomy. CASE REPORT A 41-year-old woman with a history of laparoscopic Roux-en-Y hepaticojejunostomy presented with recurrent biliary stones, most likely secondary to progressive anastomotic stricture leading to bile stasis. She had previously undergone 2 laparoscopic revisions due to early recurrence. Imaging revealed a large filling defect above the previous anastomosis. A third laparoscopic exploration was performed. Severe adhesions were carefully dissected, and the previous anastomosis was identified with the assistance of indocyanine green fluorescence imaging. The impacted stone was removed, and intraoperative choledochoscopy confirmed complete clearance of the intrahepatic bile ducts. Reconstruction was performed using interrupted 4-0 polydioxanone sutures with a mucosa-to-mucosa technique, ensuring a wide and tension-free anastomosis to reduce the risk of restenosis. The postoperative course was uneventful. During the 6-month follow-up period, she remained asymptomatic without episodes of cholangitis or jaundice, and imaging confirmed a patent anastomosis with no evidence of stone recurrence. CONCLUSIONS A third laparoscopic redo hepaticojejunostomy can be feasible in carefully selected patients. Adequate anastomotic diameter, meticulous adhesiolysis, and precise identification of the previous anastomosis are critical to minimizing recurrence. Indocyanine green fluorescence imaging can be a useful adjunct in complex redo biliary surgery.