Robotic repair of common bile duct injury with Roux-en-Y hepaticojejunostomy

Abstract

Background: We present the technique of Robotic Roux-en-Y hepaticojejunostomy for repair of common bile duct injury. The patient is a 55 yo F who presented with acute cholecystitis. She underwent a laparoscopic cholecystectomy after which she experienced increasing pain and fevers. A CT was obtained which showed perihepatic fluid, a drain was placed which returned bilious fluid prompting transfer. An ERCP was performed which showed no filling of the common hepatic duct. A percutaneous transhepatic biliary drain was placed, she was treated with antibiotics and allowed to recover. 6 weeks later she was taken to the OR for robotic Roux-en-Y hepaticojejunostomy. Methods: We start laparoscopically and after freeing multiple adhesions the small bowel is run in order to locate the appropriate segment of jejunum which is then pexed to the stomach to facilitate later reconstruction. We then turn our attention to the area underneath the liver where there are multiple dense adhesions. These are taken down and a generous Kocher maneuver is performed exposing the IVC. As we continue to work, the biloma cavity is entered and the cholangiocatheter is easily visible. We then work to dissect out the structures of the porta hepatis and work to circumferentially free the common bile duct distal to the area of injury. The previously placed surgical clips are then removed and transected the distal CBD using a stapler. Results: We then dissect the inflammatory tissue away from the proximal CBD exposing healthy duct for our anastomosis. The then set about performing a standard a standard roux en Y reconstruction. A stapled side to side small bowel anastomosis is created and the common enterotomy is closed in 2 layers. We then perform the hepaticojejunostomy with a series of interrupted absorbable sutures. A drain is then placed and the case finished.