Robotic Roux en Y Hepaticojejunostomy Reconstruction of Common Hepatic Duct Injury after Laparoscopic Cholecystectomy

Abstract

https://drive.google.com/file/d/1R5MAMvsKnHpXWYNs_t2886sX0HHkyDH5/view?usp=sharing Purpose: Iatrogenic biliary tree injuries remain a devastating, uncommon yet persistent risk after cholecystectomy. Precise reconstruction is critical to attenuate significant morbidity and mortality. The perioperative outcome of these unfortunate patients can be further augmented via the robotic platform by offering minimally invasive reconstruction in this safe, feasible and effective approach. Method: A 68 year old woman with morbid obesity was transferred from an outside hospital after a nine hour laparoscopic cholecystectomy with ERCP, MRCP and CT scan findings concerning for a complete transection of the common hepatic duct. After careful review of imaging and prior procedural findings, the patient was offered and agreed to undergo robotic roux en y hepaticojejunostomy reconstruction. Results: Total operative time was under 6 hours. The patient recovered uneventfully, tolerated a diet on postoperative day two and was discharged home without a drain on postoperative day three. At her first clinic follow up on postoperative day twelve, the patient continued to show good recovery without evidence of biliary anastomotic stricture or leak. Conclusion: Iatrogenic bile duct injuries remain a persistent if uncommon complication after laparoscopic cholecystectomy; a rapid, uneventful recovery after an effective repair can be accomplished through the robotic approach.