North Texas Research Forum 2025
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Division
North Texas
Hospital
Medical City Plano
Specialty
General Surgery
Document Type
Presentation
Publication Date
2025
Keywords
choledocholithiasis, cholecystectomy, laparoscopic surgery, bile duct
Disciplines
Gastroenterology | Medicine and Health Sciences | Surgery | Surgical Procedures, Operative
Abstract
Introduction: The incidence of concomitant cholelithiasis and choledocholithiasis is 5-20%. Primary choledochlithiasis more than 3 years after cholecystectomy is an even rarer event with only a handful of case reports in the literature. Robot-assisted laparoscopic common bile duct exploration with intraoperative choledochoscopy is a relatively recent development in biliary surgery. In this report, we describe the use of this technique in a patient with rare presentation and surgically challenging anatomy. Objective: To describe a minimally invasive approach for CBD exploration with extraction of choledocholithiasis in a surgically hostile abdomen and Roux-En-Y anatomy. Methods: This report describes the case of a 60 year old male with extensive surgical history including open right colectomy with cholecystectomy, distal gastrectomy for perforated ulcer with Roux-En-Y gastrojejunostomy, and additional multiple exploratory laparotomies with large and small bowel resections, and a final surgery with end ileostomy creation. He presented to our facility with ascending cholangitis secondary to choledocholithiasis. Magnetic resonance imaging (MRI) confirmed 2 CBD stones. An advanced gastroenterologist attempted Endoscopic Retrograde Cholangiopancreatography (ERCP) with a pediatric scope, single and double balloon enteroscopy without success to reach the ampulla of Vater. We present this case as a video presentation using intraoperative footage to describe the technique used. Results: After extensive enterolysis, two large CBD stones were removed under direct visualization without any residual choledocholithiasis. The choledochotomy was closed primarily and the patient was discharged without complications. Conclusion: We are reporting a rare case of primary choledochlithiasis after more than 20 years of cholecystectomy in a patient with Roux-En-Y anatomy and very hostile abdomen using a minimally invasive approach with uneventful recovery. Based on our experience with this case, we believe that this procedure provides a promising option for treatment of choledocholithiasis that is refractory to other interventions or in patients with challenging anatomy.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Wong, Enoch; Payne, Kristen; Burdick, James; and Ahmed, Hassan, "Laproscopic Robotic-Assisted Common Bile Duct Exploration for Primary Choledochlithiasis 20 Years After Cholecystetomy in a Hostile Abdomen" (2025). North Texas Research Forum 2025. 34.
https://scholarlycommons.hcahealthcare.com/northtexas2025/34