Detailed Abstract
[BP Video Exhibition - Biliary & Pancreas (Biliary Disease/Surgery)]
[BP VE 14] Robotic Roux-en-Y Hepaticojejunostomy for Biliary Stricture after Iatrogenic Bile Duct Injury with ICG-guided Fluorescence
Luigi RESCIGNO 1, Gianluca CASSESE 1, Silvia CAMPANILE 1, Mariano Cesare GIGLIO 1, Gianluca ROMPIANESI 1, Roberto MONTALTI 1, Roberto Ivan TROISI 1
1 Minimally Invasive And Robotic HPB Surgery, Federico II University, ITALY
Background : Iatrogenic bile duct injury (IBDI) is a severe and life-threatening complication. Different biliary reconstructions have been reported in the surgical treatment of IBDI.
Methods : A 41 year-old female patient with IBDI Bismuth type 1 injury performed during laparoscopic cholecystectomy, was immediately converted and repaired with the positioning of T-tube. Post removal T-tube MRCP showed severe bile duct stenosis with upstream dilatation associated with increased cholestasis. After failed attempts endoscopic dilation we indicated a redo surgery with HEP-JEJ.
Results : After extensive lysis of adhesions, the robot was docked. Firefly helped us to have a good view of the hilar structures around the CBD. After its distal closure with an hem-o-lock, upwards dissection was ultimate with careful attention to preserve the right hepatic artery. The CBD stenosis was identified by axial opening of the duct as well as the pre confluence point. A jejunal limb was isolated and divided 20 cm from the Treiz angle. An end-to-side HJ was performed using an interrupted 5-0 PDS suture and 2 Archimedes reservable stents were positioned into the left and the right ducts. The distal jejuno-junostomy was constructed 70-80cm distally using a linear stapler. A tubular drain was placed. The patient was discharged after 7 days, with no postoperative complications.
Conclusions : Robotic HJ may offer a great minimally invasive approach for IBDI.
Methods : A 41 year-old female patient with IBDI Bismuth type 1 injury performed during laparoscopic cholecystectomy, was immediately converted and repaired with the positioning of T-tube. Post removal T-tube MRCP showed severe bile duct stenosis with upstream dilatation associated with increased cholestasis. After failed attempts endoscopic dilation we indicated a redo surgery with HEP-JEJ.
Results : After extensive lysis of adhesions, the robot was docked. Firefly helped us to have a good view of the hilar structures around the CBD. After its distal closure with an hem-o-lock, upwards dissection was ultimate with careful attention to preserve the right hepatic artery. The CBD stenosis was identified by axial opening of the duct as well as the pre confluence point. A jejunal limb was isolated and divided 20 cm from the Treiz angle. An end-to-side HJ was performed using an interrupted 5-0 PDS suture and 2 Archimedes reservable stents were positioned into the left and the right ducts. The distal jejuno-junostomy was constructed 70-80cm distally using a linear stapler. A tubular drain was placed. The patient was discharged after 7 days, with no postoperative complications.
Conclusions : Robotic HJ may offer a great minimally invasive approach for IBDI.
SESSION
BP Video Exhibition
Video Exhibition 3/21/2024 12:00 AM - 12:00 AM