OGBN V03 Robotic choledochoduodenostomy for benign common bile duct stricture

Abstract Background A 54-year-old male patient was referred with benign distal common bile duct (CBD) stricture secondary to chronic pancreatitis. He had multiple admissions with recurrent cholangitis requiring numerous Endoscopic Retrograde CholangioPancreatographies (ERCPs) and stent exchanges including SpyGlass procedure which did not demonstrate evidence of malignancy. His quality of life was poor due to debilitating pain and recurrent hospital admissions so he was offered elective choldechoduodenostomy aiming to bypass the bile duct stricture, but also allowing continued endoscopic surveillance. Methods A robotic choledochoduodenostomy was performed using the DaVinciXi system, a 12mm Airseal and four 8mm robotic ports. The patient was supine with split legs(15degrees) in reverse Trendelenburg position with a slight left tilt. Initially, robotic cholecystectomy was carried out following which the CBD was dissected and its anterior wall delineated. The duodenum was kocherised to allow sufficient mobility for anastomosis. Subsequently, a longitudinal choledochotomy was performed and a metal stent was extracted. Then, an enterotomy was made perpendicularly to the choledochotomy. A choledochoduodenostomy was performed using continuous 4-0-V-Loc sutures for posterior wall and 4-0-PDS continuous sutures for anterior wall. Results The post-operative period was uncomplicated. The patient experienced minimal pain after procedure and was discharged home on post-operative day 2. He was reviewed in outpatient clinic 6 weeks after, and reported he had successfully discontinued all regular opiates and benzodiazepines previously used for pain control. Conclusions A robotic choledochoduodenostomy is an excellent alternative for the treatment of benign bile duct strictures in patients with recurrent cholangitis requiring repeated stent exchanges. Moreover, it has the advantage of continued endoscopic surveillance which is not possible with traditional hepatico-jejunostomy.