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 UNUSUAL CASE
Year : 2020  |  Volume : 16  |  Issue : 4  |  Page : 431-434

Robotic-assisted laparoscopic common bile duct exploration with hepaticojejunostomy for primary ductal stones in nonagenarians: A report of two cases


1 Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
2 Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital; Duke-National University of Singapore Medical School, Singapore

Correspondence Address:
Dr. Brian K. P. Goh
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Academia Level 5, Singapore 169856
Singapore
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_295_19

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Experience with complex robotic-assisted laparoscopic (RAL) hepatobiliary and pancreatic (HPB) surgery remains limited to few tertiary institutions worldwide. In this report, we focus on biliary bypass surgery, one of the more complex HPB surgeries. Over the past few decades, the laparoscopic approach has gained preference over the open approach, but the robotic approach is still uncommon. Biliary bypass is also not often performed in nonagenarians due to its inherent-associated morbidity and mortality, and these patients typically have higher surgical risks. We present two cases of nonagenarians who had recurrent episodes of cholangitis secondary to multiple primary common bile duct (CBD) stones and ectatic bile ducts. Both the patients were treated conservatively over many years with repeated endoscopic retrograde cholangiopancreatography and stentings. They eventually presented to us and underwent successful RAL CBD exploration with hepaticojejunostomy.






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