Roux-en-y Hepaticojejunostomy Assisted by Robot after Bile Duct Injury: Case Report and Literature Review - Abstract
Introduction: Roux-en-Y hepatojejunostomy (RYHJ) by open approach is the standard therapy for the repair of iatrogenic bile duct injuries (IBDI). Laparoscopic and robotic surgery represent an alternative that offers the inherent benefits of minimal invasion, although it is a highly demanding challenge due to the complexity in the dissection and in the bilioenteric anastomosis, therefore it’s use has been limited. Clinical case: A 41-year-old female patient underwent a laparoscopic cholecystectomy for chronic cholecystitis, complicated with Strasber E3 type IBDI. The initial management was a laparoscopy in order to evacuate the bilioperitoneum and place drainages. 22 days after the cholecystectomy, a RYHJ robotic assisted was performed, without transoperative complications. During her evolution, laparoscopy was required for hemostasis due to bleeding from a port wound on the skin. She also presented a biliary leak on day 8 with low debit, spontaneously remitting at day 12. At 6 months of follow-up she is asymptomatic with normal liver function tests. Discussion: Although day to day minimally invasive surgery displaces the open approach in various surgical procedures, the RYHJ has shown a limited evolution. The few reports so far are encouraging, with functional results comparable to the open approach but with the benefits of minimal invasion, however the level of evidence is still very low and its real role has yet to be defined.