論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	その他(不明)
表題	Retroperitoneal-First Laparoscopic Approach (Retlap) for Bile Duct Resection in Pancreaticobiliary Maljunction (PBM): A Novel and Reasonable Approach to Intrapancreatic Bile Duct.
掲載誌名	正式名：Annals of surgical oncology 略　 称：Ann Surg Oncol ISSNコード：15344681/10689265
掲載区分	国外
巻・号・頁	33(6),pp.5833-5834
著者・共著者	Takuma Karasuyama, Gozo Kiguchi, Keiko Kubota, Kazuyuki Nagai, Osamu Takeyama
発行年月	2026/06
概要	BACKGROUND:Pancreaticobiliary maljunction (PBM) is a congenital anomaly in which the pancreatic and bile ducts join outside the duodenal wall.1,2 Reflux of pancreatic juice induces chronic inflammation and epithelial regeneration, promoting carcinogenesis. Biliary dilation increases the risk of cholangiocarcinoma, and prophylactic resection of the extrahepatic bile duct and gallbladder is recommended even for asymptomatic patients.3,4 To prevent postoperative carcinogenesis, the intrapancreatic bile duct should be transected just above the pancreatobiliary junction. The authors describe a novel dorsal approach to the pancreatic head using the retroperitoneal-first laparoscopic approach (Retlap).5-7 METHODS: A 73-year-old woman under follow-up evaluation for choledocholithiasis-associated cholangitis was found to have a gallbladder tumor. Evaluation showed PBM with biliary dilation. Computed tomography exhibited wall-thickening of the gallbladder fundus. Magnetic resonance cholangiopancreatography demonstrated a common bile duct diameter of 13 mm and a common channel length of 12 mm, whereas endoscopic retrograde cholangiopancreatography measured both as 15 mm. Biliary amylase was elevated. The preoperative diagnosis was gallbladder carcinoma with PBM and biliary dilation. After an explanation of the procedure and her informed consent, the woman underwent extrahepatic bile duct and gallbladder resection with lymphadenectomy using Retlap.RESULTS:The operative time was 480 min, including 210 min for Retlap, with 40 mL blood loss. The postoperative course was uneventful, and she was discharged on postoperative day 14. Pathology confirmed gallbladder carcinoma with single-node metastasis. At this writing, after adjuvant chemotherapy, the woman has remained recurrence-free 3 years.CONCLUSION:Although additional trocars and steps are required, Retlap for PBM may enable safe bile duct transection just above the pancreatobiliary junction and facilitate lymphadenectomy, providing excellent visualization and stable maneuverability.
DOI	10.1245/s10434-026-19491-7
PMID	41855019