Ann Hepatobiliary Pancreat Surg.  2024 Aug;28(3):393-396. 10.14701/ahbps.24-063.

Komi type 2 pancreaticobiliary maljunction: Minimal access surgical treatment (with video)

• Graterol FP
• Marcano FS
• Rivero-Moreno Y
• Barrios YV

• KMID: 2558649
• DOI: http://doi.org/10.14701/ahbps.24-063

Abstract

Pancreaticobiliary maljunction (PBM) is associated with the development of neoplasms of bile ducts. Cholecystectomy with diversion of the biliary-pancreatic flow is considered the treatment of choice. To describe the surgical treatment employed for a patient with Komi’s type 2 PBM and its long-term results. Laparoscopic common bile duct exploration, intraoperative cholangioscopy, and Roux-en-Y hepatico-jejunostomy were performed. Postoperative evolution was satisfactory. The patient was discharge 72 hours after the surgery. There was no associated morbidity. At 62-month follow-up, clinical examination, laboratory tests, and imaging studies confirmed an adequate patency of bilio-enteric anastomosis. The surgical approach employed was effective and safe, with satisfactory long-term results.

Keyword

Pancreaticobiliary maljunction; Extrahepatic bile duct

Figure

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  Fig. 1 Komi type 2 pancreaticobiliary maljunction (PBM). (A) Endoscopic cholangiopancreatography. (B) Komi’s PBM classification scheme. BD, bile duct; PD, pancreatic duct, Cch, common channel; D, duodenum; AP, accessory pancreatic duct; VP, ventral pancreatic duct.

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  Fig. 2 Magnetic resonance cholangiopancreatography showing a single and 29.2 mm long, biliary-pancreatic duct.

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  Fig. 3 Cosmetic postoperative result.

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  Fig. 4 Bidirectional regurgitation mechanism in pancreatobiliary maljunction. Image adjusted as presented by Kwak et al. [8] and Kamisawa et al. [9].

Reference

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