How effective is endoscopic stenting in management of post-cholecystectomy bile duct injuries – experience of a tertiary care hepatobiliary center in a developing country

Abstract

Three consecutive patients undergone robotic reoperation by daVinciÒ SI, and by the same team were reported. Patients were positioned in reverse Trendelenburg. For all patients, five trocars were used (3 of 8 mm and 2 of 12 mm), and surgical specimens were removed through Pfannestiel incisions. Results: From November 2016 to December 2017, three cases of IGBC were performed. Clinicopathological, operative and postoperative data are summarized in the table. Briefly, all patients underwent bisegmentectomy IVb/ V (1 anatomical and 2 non-anatomical) plus hilar lymphadenectomy; they were pT1b, and neither presented residual liver disease nor positive node at final pathology. Neither Pringle maneuver nor blood transfusions were necessary. All discharges from ICU and hospital were on second and third postoperative days, respectively. No complications at 30-days were recorded. Conclusion: Our initial experience suggests that robotic reoperation seems to be safe, and simplifies both hilar lymphadenectomy as well as intrahepatic control of pedicles allowing anatomic resections. The putative benefits of its approach are the articulate arms facilitating traction and dissection of hilar structures with precise movements and tridimensional view. Both articulate mono and bipolar scalpels helped to work bi-axially on the liver wedge necessary to remove segments IVb/V with their pedicles.