Laparoscopic resection of recurrent hepatic biliary cystadenoma in a patient with both accessory right and left hepatic arteries

Biliary cystadenoma (BC) of the liver is a rare benign cystic lesion. Recurrence following excision is uncommon, and aberrant hepatic arterial anatomy adds further surgical complexity. A 25-year-old female underwent laparotomy 3 years earlier for a presumed hydatid cyst; histopathology revealed mucinous BC. She presented with abdominal pain. Computed tomography (CT) showed an 8 cm × 8 cm × 7 cm multiloculated cystic lesion in segments 4a/4b/5 and another in segments 5/8 compressing the porta hepatis structures. CT angiography demonstrated both accessory right and left hepatic arteries. After pre-operative endoscopic retrograde cholangiopancreatography with common bile duct stenting, laparoscopic resection was performed with careful preservation of the portal vein and all hepatic arteries. A minor left hepatic duct injury was repaired primarily. Operative time was 210 min; blood loss was 250 ml. Recovery was uneventful. Histopathology confirmed biliary mucinous cystadenoma without malignancy. This case illustrates a rare combination of vascular anatomy encountered during laparoscopic resection of recurrent hepatic BC, and to our knowledge, it is the first published report describing this precise surgical scenario. Laparoscopic resection of recurrent BC with dual accessory hepatic arteries is feasible and safe in expert hands following detailed vascular mapping and meticulous dissection.