Michael P Meara, MD, MBA, FACS, Andrei Manilchuk, MD, Cole Rodman, Sophia Roberts. The Ohio State University Wexner Medical Center
Choledochoduodenostomy remains a treatment option for individuals with benign biliary stricture either acquired secondary to intrinsic damage, secondary to previous instrumentation, or anastomosis. Exclusion of malignant causes is imperative prior to operative biliary bypass. Our patient is a 75-year-old obese (BMI 41) Caucasian female, who presented with a past surgical history significant for laparoscopic cholecystectomy for acute cholecystitis in 2016. She subsequently underwent five previous ERCPs with biliary dilation and stenting for benign biliary stricture. Here ERCP and stenting included a self-expanding metal stent which was subsequently removed after four months’ time. EUS was also performed to ensure no underlying malignancy. Despite these maneuvers, a recurrent stricture was experienced and a robotic biliary bypass was undertaken.
The patient was brought to the operating room and robotic choledochoduodenostomy the previously removed gallbladder fossa was defined. The cystic duct stump was localized and the common bile duct was identified. Likewise, the duodenum was mobilized and a limited Kocher maneuver was performed. Once the anatomy was defined, a duct to mucosa anastomosis was performed with 5-0 absorbable monofilament suture. The patient did well postoperatively and was discharged home on postoperative day #2. She reported at one-month follow-up to be without symptoms and only requiring four doses of extra-strength acetaminophen in the post-operative period for pain control.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95918
Program Number: V023
Presentation Session: HPB Videos
Presentation Type: Video